Chapter 19- Peripheral Nerve Injuries

Question 1

PNI’s are caused by….? (2)

Answer 1

1. Trauma

2. Entrapment / Compression

Question 2

When a nerve is entrapped in more than one location along the pathway it is a…?

Answer 2

Double or Multiple Crush Syndrome

Question 3

Why are nerves more susceptible to injury

Answer 3

Because they move between soft tissue structures and bony prominances

Question 4

Symptoms are PNI’s

Answer 4

weakness or paralysis of the muscles (motor branch) sensory loss (sensory branch)

Question 5

Early Symptoms of the compression neuropathy

Answer 5

a combination of pain, tingling, numbness & weakness

Question 6

How should the Splint be placed for PNI’s?

Answer 6

so that tension and stress is decreased on the nerve

Question 7

The more … the diagnosis the WORSE the prognosis

Answer 7

Proximal

Question 8

PN have … regeneration potential

Answer 8

Excellent

Question 9

The PNS serves as a transporter of neural impulses between

Answer 9

receptors - muscles and CNS

Question 10

A bundle of Axons in the PNS = ?

Answer 10

Nerve

Question 11

After a Nerve has been injured the changes are called ?

Answer 11

Wallerian Degenration

Question 12

A nerve is surrounded by … ?

Answer 12

3 layers - epineurium, perineurium and endonurium

Question 13

A crush injury leaves … intact

Answer 13

conduit tissue layers

Question 14

A severed nerve needs

Answer 14

Surgery

Question 15

First Degree Injury - Neuropraxia

Answer 15

Demyelinating Injury with a temporary conduction block (COMPLETE RECOVERY)

Question 16

Axonotmesis - 2

Answer 16

Distal Degenration of the injured axon but with almost always complete regeneration (intact endonureum) (COMPLETE RECOVERY)

Question 17

Neurotmesis - 3

Answer 17

Regeneration occurs but is incomplete (endoneurial scarring) (OUTCOMES VARY)

Question 18

4th Degree Injury

Answer 18

Axon, Endonuerium and Perinurium are disrupted SURGERY IS RECOMMENDED

Question 19

5th Degree Injury

Answer 19

Severed Nerve Trunk (No possibility of spontaneous regeneration) NEEDS SURGERY

Question 20

Tinels Sign

Answer 20

technique to assess nerve regeneration = gentle tapping along the nerve pathway Distal to Proximal

Question 21

6th Degree Injury

Answer 21

a mixed lesion that includes normal fascicles with all OR any of the 5 degrees of Injury

Question 22

Epineurial Repair

Answer 22

quick and simple, most common repair - Epineurium is debrided till no signs of damage

Question 23

Perineurial Repair

Answer 23

2nd most common repair- the outer and inner epineurium are dissected away from the nerve stumps and the fascicles and matched together

Question 24

End-to End Repair

Answer 24

clean nerve ends sutured together

Question 25

End to Side Repair

Answer 25

SENSORY RECONSTRUCTION. Proximal stump is sutured to the side of a distal receptor

Question 26

Neurorrhaphy

Answer 26

suturing of a divided nerve

Question 27

Neurosensory Flaps

Answer 27

innervated flaps that provide sensory feedback

Question 28

Spontaneous PN growth requires ... ? (2)

Answer 28

axon regrowth and demyelination by Shwann Cells

Question 29

Nerve Grafting

Answer 29

provides a regenerating axon with a protective pathway to a distal stump

Question 30

Nerve Conduit

Answer 30

connects neural gaps to contain, align and direct the regenerating axons. Autogenius or synthetic material Early active motion is allowed

Question 31

High Lesion

Answer 31

Injury Proximal to the elbow

Question 32

Martin Gruber Connection

Answer 32

a portion of the median nerve communicates with the ulnar nerve in the Proximal 1/3 of the Forearm

Question 33

Riche Cannieu Connection

Answer 33

Recurrent branch of the median nerve and the deep branch of the ulan nerve (intrinsic thenar muscles)

Question 34

MEDIAN NERVE- High Peace Sign Deformity

Answer 34

``` Forearm Pronation Wrist Radial Flexion PIP Flexion IF and MF DIP & MCP Flexion Thumb IP Flexion Thumb MP Flexion Volar Sensation ```

Question 35

MEDIAN NERVE - Low Ape Hand Deformity

Answer 35

IF and MF MCP Flexion Thumb Opposition & Palmar ABD Thumb MP Flexion Volar Sensation

Question 36

ORTHOSIS - FLEXOR TENDONS

Answer 36

Wrist/Hand Immobilization Orthosis

Question 37

Pronator Syndrome

Answer 37

Compression in the Proximal Forearm = pain/ parathesis in the Volar Forearm and Hand. POSISTIVE TINEL SIGN. ORTHOSIS= Elbow FLXN, Pronation and Wrist Neutral

Question 38

Anterior Interosseous Nerve Syndrome

Answer 38

MOTOR lesion 2x2 to Trauma SYMPTOMS= weakness/ paralysis of the FPL and pronator quadrates muscle CANNOT to tip touch, X make an OK sign

Question 39

CTS

Answer 39

volar pain and weakness, numbness, nocturnal burning pain, clumsiness DIFFICULTY with fine motor manipulation Positive Tinel's Sign

Question 40

ULNAR NERVE - High Claw Hand Deformity

Answer 40

``` Ulnar wrist flexion DIP AND MCP FLX of 4 and 5 ADD & ABD Thumb ADD Thumb MP FLXN DORSULNAR SENSORY LOSS Loss of Pinch and grip ```

Question 41

ULNAR NERVE - Low

Answer 41

``` MCP FLX of 4 and 5 ADD & ABD Thumb ADD Sensory Loss of Ulnar Aspect Grip and Pinch ```

Question 42

Median + Ulnar Nerve Injury =

Answer 42

Claw Hand Deformity

Question 43

Contraindications to Heat:

Answer 43

1. Impaired skin sensation 2. impaired vascular supply 3. arterial disease 4. bleeding disorder 5. recent or potential hemorrhage 6. inflammatory conditions 7. malignancies 8. very old/young 9. infections 10. Pregnancies 11. If Icy-hot/ Bengay was applied 12. edema 13. recent wound or tendon repair 14. open wounds, burn wounds or recent grafts

Question 44

Hot packs must be wrapped in ... layers to prevent burning?

Answer 44

8-10 layers

Question 45

After making sure your patient is reliable you want to check after ... minutes. And check every .... minutes?

Answer 45

3 and check every 5