Peripheral Nerve Injury Flashcards
discuss Seddon classification
neurapraxia - focal conduction block only
axonotmesis - axonal disruption c wallerian
neurotmesis - complete severerance of axon and all layers
discuss Sunderland classification
1st degree - neurapraxia; conduction block
2nd degree - axonotmesis but other layers are still intact
3rd degree - axon and endoneurium
4th degree - axon, endoneurium and perneurium
5th - axon, endoneurium, perineurium, epineurium
causes of nerve injury
compression: sustained pressure or from bone, tumor, impingement
laceration: GSW, knife, surgery, injection
stretch - excessive traction force
radiation: xrays…
electricity
significance of nature and level to recovery
more proximal = more disruption kc mas madami fibers tatamaan
more traumatic injuries = more damage
compression and entrapment - mas ok
laceration and crush - worse
significance of timing and technique of repair to recovery
sooner the better and need skill of surgeon
discuss regeneration potentials of nerves
excellent: radial, musculocutaneous, femoral
moderate: median, ulnar and tibial
poor: peroneal
significance of age and motivation to recovery
older = slower regeneration
more motivated to do PT = better recovery
what is the regeneration rate of nerves per day
1-2 mm/day
what are the intrinsic and extrinsic factors to recovery
intrinsic: age, time, type of injury, nutrition, nerve involved
extrinsic: surgical treatment and therapy
significance of bilateral provocative test
(+) = poor prognosis and larger extent of lesion
CTS often resolves p ____
6 mo after onset
maximal benefits of conservative tx for CTS
at 3 mo
conservative tx can improve sx within _____
2-6 wls
when should you consider new tx approach
if tx is not working after 6 wks
poor prognosticating factors
advanced age
d/t dislocation
prior radiation
gap > 2.5 cm
proximal
