Peripheral Nerve Injury

Question 1

Hand Injuries

Answer 1

• 1/3 of ER visits
• 2/3 occur in working years
• 1/4 of all disabiling work injuries (1/6 fingers)
• 1/4 of athletic invlove hand and wrist

Question 2

Cause of Peropheral Nerve Injury

causes of weakness and deformities

Answer 2

Trauma

Question 3

Assessment of Injuries

Answer 3

• penetrating
• crushing
• stretching
• Ischemia

Question 4

Seddon’s Classification

Classification of Injuries

Answer 4

• increasing severity
• extent of nerve damage

Question 5

Neurapraxia

Seddon’s Classification

Answer 5

• Class I
• transient episode of complete motore paralysis
• little seonsory or autonomic involvemnet
• once pressure is relieved complete return of function follows

Question 6

Axonotmesis

Seddon’s Classification

Answer 6

• Class II
• loss of continuity of the axon with maintenance of continuity of shwann sheath
• motor, sensory, and autonomic paralysis is complete
• time necessary to recover function depends on distance between the denervated muscle and proximal regenerating axon

Question 7

Neurotmesis

Seddon’s Classification

Answer 7

• Class III
• complete loss of continuity of both axon and shwann sheath
• recovery rarely is complete and amount of loss can only be determined over time

Question 8

Extensor Tendon Classification

zones of hand

Answer 8

• 8 unique zones

Question 9

Flexor Tendon Classification

zones of hand

Answer 9

• 5 zones
• surgical repair of flexor tendon injuries in zone two is challenging due to difficulty in preserving smooth gliding properties of tendons in this area

Question 10

Mechanism of Injury

Complete Brachial Plexus injury

Answer 10

Children: birthing injury
Adults: MVA
Results in flail arm (exception of traps)

Affects C5-T1

Question 11

Intervention

Complete Brachial Plexus Injury

Answer 11

“prosthosis”
stanmore flail arm orthosis

Question 12

Ulnar Nerve Lesion @ Wrist

Answer 12

• intrinsic muscle paralysis

Question 13

Ulnar Claw Hand

Ulnar Nerve Lesion @ Wrist

Answer 13

• hyperextension of MCPs
• flexion of IPs
• NOT Hand of Benediction

Question 14

Orthotic Recommendation

Ulnar Nerve Lesion @ Wrist

Answer 14

• HO
• MCP 4/5 extension stop
• IP extension assist
• 1st dorsal interosseous assist

Question 15

Median Nerve Lesion @ Wrist

Presentation

Answer 15

• loss of thumb opposion
• loss of sensation

Question 16

Orthotic Recommendation

Median Nerve Lesion @ Wrist

Answer 16

• HO with opponens bar
• MCP 2 and 3 extension stop
• IP extension assist

Question 17

Radial Nerve Lesion @ Elbow

Answer 17

• loss of wrist and MCP extension
• weakness in thumb ABduciton and extension

Question 18

Orthotic Recommendation

Radial Nerve Lesion @ Elbow

Answer 18

• WHO wrist extension assist
• Thumb ABduction assist and/or Adduction stop
• MCP extension assist

Question 19

Combined Med/Ulnar Lesion

Answer 19

• claw hand (loss of MCP flexion)
• Loss of thumb opposition and sensation

Question 20

Orthotic Recommendation

Combined Med/Ulnar Lesion

Answer 20

• MCP extension stop 2-5
• IP extension assist