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
management for acute phase
ROM exercises and immob/splinting
management for recovery phase
motor retraining - place and hold
electrical stim - NMES and FES
AAROM and PREs
management for chronic
compensatory and preventive care
modalities used
splinting, TENS, heat and cold
US for pain
ES for denervated
desensitization for hypersensitivity
exercises in PNI
ROM, isoms
dexterity exercises
scar mob, neural mob and tendon gliding
