PERIPHERAL NERVE INJURIES

Presented by
Ms Sadaf
MPT(neurology) 1st yr.
 Physiology of a peripheral
Anatomy of a peripheral nerve
nerve

Overview of the peripheral nervous

system
Nerve pathology
Mechanism of nerve injury
Double –crush syndrome
Classification of nerve injury
Specific nerve lesions
 - Nerve lesions affecting the head and neck
 - Nerve lesions affecting the upper extremity
 - Nerve lesions affecting the lower extremity
Nerve degeneration and regeneration
Functional recovery from peripheral nerve injury
CLASSIFICATION OF
PERIPHERAL NERVE INJURY
Nerve Mechanism of injury
 Axillary  Anterior shoulder dislocation , trauma
during anterior shoulder stabilization
procedures ,fractures of the humeral neck

 Musculocutaneous
 Radial
 Clavicular fracture
Nerve
 Humeral fracture, compression in the radial
 Median tunnel
Nerve  Entrapment in pronater teres,Compression in
 Ulnar the carpal tunnel
 Cross pinning following supracondylar
fracture ,entrapment in the cubital tunnel and
guyon’s tunnel

Upper extremity
Major nerve injuries of the U.E
Lower Extremity
Nerve Degeneration and
Regeneration
RATE OF NERVE
REGENERATION BY REGION
Upper arm 2.5-8.5 mm/day
Proximal forearm 2-6 mm/day
Wrist 1-2mm/day
Hand 1- 1.5 mm/day
Upper leg 2 mm/day
Lower leg 1.5 mm/day
ankle 1mm/day
EXAMINATION
Patient histroy
System review
Tests and measures
- musculoskeletal
* posture
* anthropometric characteristics – edema
* range of motion and muscle length
* muscle performance- british medical
research council developed scale
modified by dellon
British Medical Research
Council Scale Of Nerve Function
 Muscle function
 M0
 No contraction

 M1
 Perceptible contraction in proximal
muscles
 M2  Perceptible contraction in proximal and
distal muscle

 M3  Contraction with sufficient power to

allow movement against resistance

 M4  Return to function as in stage 3 but

synergistic and independent movement
are possible

 M5  Complete recovery
Sensory Function

 S0  Absence of sensibility in the

autonomous area
 S1
 Recovery of deep cutaneous pain
in the autonomous area
 Recovery of some degree of
 S1+ superficial cutaneous pain
 S2  S2but with over response
 Return of superficial cutaneous
 S2+ pain and tactile sensitivity
throughout the autonomous
area ,with disappearance over
response ,static 2-point
discrimination >15mm
 S3  S3,with localization and recovery
of 2-point discrimination at 7-
15mm in the autonomous area
 Complete recovery with static 2-
 S4 point dicrimination at < 6mm
 Neuromuscular
* Pain
* Cranial and peripheral nerve integrity
_ electrophysiological testing
_ provocative tests to detect nerve injury
~ Tinel’s Test
~ Ross Test
~ Neural Tension Tests
~ Elbow Flexion Test
~ Phalen’s Test
~ Carpal Compression Test
~ Piriformis Tests
~ Autonomic Tests
Monofilament testing of tactile
sensation
Testing of 2-point dicrimination
◦ STATIC 2 POINT INTERPRETATION
DISCRIMINATION

Normal
◦ Less than 6 mm
Fair
◦ 6-10mm
◦ 11-15 mm Poor
◦ One point perceived Protective
◦ No point perceived anaesthetic
SENSORY TESTING
SENSATION CLINICAL
TESTING TOOL
Pain Safety pin

Temperature Hot/cold water tubes

Light Cotton swab

touch
Vibration Tuning fork

propioception Passive movement by

examiner
Disk-criminator morberg pickup
References
 Physical Rehabilitation – Michelle H.Cameron and Linda G.
monroe
 Human Anatomy – B.D.Chaurasia
 Cash’s Textbook of Neurology for Physiotherapists – Patricia A.
Downie
 Textbook Of Physiology – Prof.A.K.Jain
 Am J Phys Med Rehabil 2003;82:86-95
 Neurorehabilitation and Neural Repair , vol 22, no. 4, 367-373
(2008)
 Neurosurgery 2001 may;48(5):1136-40
 The Journal of Neurosciences, August 1,200222(1);6631-6638
 Acta Newurochir Suppl(2007) 100 ;127-129
 Arch Phys Med Rehabil Vol 85, September 2004
 Journal Of Brachial Plexus And Peripheral Nerve Injury2009;4:17
 Journal Of Hand Therapy
 Thank

you