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Traumatology > Traumatic Injuries of Peripheral nerves > Flashcards

Traumatic Injuries of Peripheral nerves Flashcards

1
Q

What are the constutions of the Nerve

A
  • Axon
  • Dendrites
  • Endoneurium
  • Perineurium
  • Epineurium
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2
Q

Endoneurium?

A

surrounds undividual axon

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3
Q

Perineurium?

A

a layer of connective tissue that
surrounds groups of axons called fascicles

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4
Q

Epineurium?

A

a layer of connective tissue that
covers the outer surface of your nerve.

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5
Q

What is the first thing to do in front of nerve injury

A

determine whether the
injury results in an open or closed lesion.

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6
Q

What are the two classification of peripheral nerve injury?

A
  • Seddon’s classification
  • The Sunderland classification
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7
Q

Seddon’s classification vs Sunderland classification?

A
  • The Sunderland classification is an expansion of the Seddon classification, which divides axonotmesis into 3 stages and contains 5 grades.
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8
Q

stages of Seddon’s classification?

A
  • neuropraxia,
  • axonotmesis,
  • Neurotmesis
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9
Q

Neuropraxia?

A
  • the mildest type
  • A temporary blockage of nervous conduction caused by a segmental demyelinization( compression, stretshing)
  • Motor paralysis, and some proprioceptive and tactile sensitivity loss
  • maintenance of thermal and pain sensitivity in most cases
  • no distal axonal degeneration.
  • recovery in days or weeks
  • Grade 1 of the Sunderland classification
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10
Q

Axonotmesis?

A
  • the loss of axonal continuity.
  • nerve connective tissue framework is preserved
  • spontaneous regeneration is s possible- weeks to months
  • wallerian degeneration occurs in the nerve segment distal to the injury
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11
Q

Whata are the three grades of Axonotmosis depending on The Sunderland classification?

A
  • Grade 2: Loss of continuity of the axon and its myelin sheath, endoneurium, epineurium and perineurium are preserved
  • Grade 3: : The axon and the endoneurium are damaged but not the perineurium
  • Grade 4: The axon, the endoneurium and the perineurium are damaged but the epineurium is preserved
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12
Q

Neurotmesis?

A
  • A rupture occurs in the epineurium with macroscopic loss of nerve continuity
  • complete sensory and motor
    deficits.
  • wallerian degeneration : the nerve segment distal to the injury
  • No spontaneous regeneration < surgical
    treatment.
  • grade 5 of the Sunderland
    classification
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13
Q

What the Musculo-cutaneous nerve innervate ?

A
  • innervates the three muscles of the anterior compartment of the arm: the coracobrachialis, biceps brachii, and brachialis muscles
  • cutaneous innervation of the lateral forearm
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14
Q

What are the symptoms of Musculo-cutaneous nerve injury?

A
  • weakness in elbow flexion or shoulder
    flexion,
  • atrophy of the biceps brachii
  • pain or paresthesia at the lateral
    forearm.
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15
Q

What causes the Musculo-cutaneous nerve injury?

A
  • iatrogenic causes secondary to prolonged
    positioning of the arm during an unrelated
    surgery.
  • direct injury to the nerve during surgery.
  • Repetitive, vigorous upper extremity
    activity (e.g. lifting, throwing, or carrying),
    or a single forceful extension of the upper
    extremity (e.g. pushing or wrestling)
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16
Q

What the axillary nerve innervate?

A
  • teres minor and deltoid muscles
  • skin of the shoulder
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17
Q

What are the symptoms of Axillary nerve injury?

A
  • A weakness in shoulder abduction
  • numbness to the lateral shoulder area.
  • weakness in glenohumeral external rotation; may not be apparent due to the infraspinatus.
18
Q

What does the Median nerve innervate?

A
  • the flexor muscles of the forearm and hand.
  • skin of the hand
19
Q

What are the symptoms of Median nerve injury at the level of the wrist?

A

Carpal tunnel syndrome:
- Thenar weakness, Thenar amyotrophy
- Numbness in the radial three and one-half fingers, and paresthesias.
- Burning like pain
- worse at night
- Positive Tinel and Phalen tests
- Cubital fossa tenderness or swelling

20
Q

What are the syndroms that can ocure when the median nerve is injured at the leve of the elbow?

A
  • Pronator Syndrome
  • Anterior Interosseous Neuropathy
21
Q

What are the symptoms of the Pronator Syndrome?

A
  • the pronator teres compresses the median
    nerve- Passes between its two head
  • discomfort in their forearm with activity.
  • numbness and tingling of the thumb, and the first two digits.
  • Nagative Phalen and Tinel signs
22
Q

What are the symptoms of the Anterior Interosseous Neuropathy?

A
  • No sensory deficit
  • unable to approximate the thumb and index finger- he cannot make ok sign
23
Q

what does the radial nerve innervate?

A
  • triceps brachii
  • the brachioradialis and extensor carpi radialis longus (muscles of the posterior forearm)
  • the skin on the dorsum of the hand
24
Q

Injury of the radial nerve at the axilla?

A
  • Saturday night palsy- Compression
  • loss of extension of the forearm, hand, and fingers (wrist drop).
  • sensory loss in the lateral arm and in the
    posterior aspect of the forearm, radiating to the radial aspect of the dorsal hand and digits.
25
Q

injury of the radial nerve the albow?

A
  • weakness in the extension of the hand and fingers and the presence of finger drop and partial wrist drop.
26
Q

Posterior interosseous nerve syndrome?

A
  • pain in the forearm and wrist,
    along with weakness with finger metacarpal extension and wrist extension.
27
Q

Wartenberg syndrome?

A
  • No motor deficit
  • numbness and tingling in the radial half of the dorsum of the hand and the dorsum of the radial 3 1/2 digits.
28
Q

Injury of the ulnar nerve at the elbow?

A
  • Numbness and paresthesia, radiating distally to the ulnar aspect of the hand, the fifth digit and the ulnar aspect of
    the fourth digit.
  • Decrease in handgrip and pinch strength (Froment sign)
  • sever: claw hand
29
Q

Injury of the ulnar nerve at the wrist?

A
  • Hypothenar atrophy
  • weakened finger abduction and adduction
  • weakened thumb adductor (froment sign)
  • sensory loss and pain: the palmar surface of the fifth digit and medial aspect of the fourth digit & the
    dorsum of medial aspect of the fourth finger and the dorsum
    of the fifth finger
  • claw hand - sign of Benediction
30
Q

Femoral nerve injury?

A
  • weakness in hip flexion and knee extension
  • sensory disturbances:
  • the front of the thigh
  • The medial side of the knee, leg,
    and foot.
  • The patellar reflex is
    reduced
    abolished.
31
Q

Obturator nerve injury?

A
  • sensory loss in the medial thigh
  • Weakness of the adduction and internal rotation of the thigh
  • medial thigh wasting
32
Q

Tibial nerve injury- Tarsal tunnel syndrome?

A
  • knee and ankle injury
  • altered sensation: the sole of the foot
  • loss of plantar flexion, loss of
    flexion of toes and weakened inversion
33
Q

Mechanisms of Common fibular nerve injury?

A
  • Knee disclocation
  • fibula trauma
  • habitual leg crossing
34
Q

Symptoms of Common fibular nerve injury?

A
  • weakness of ankle dorsiflexion < foot
    drop.
  • Steppage gait (foot drop gait)
  • oss of sensation: the lateral leg, dorsal foot, the first toe webspace.
35
Q

two common pathologies involving the damage to the superficial fibular nerve?

A
  • entrapment: ankle sprains or twisting
    of the ankle
  • direct damage: fracture of the fibula,
    or by a perforating wound to the
    lateral side of the leg.
36
Q

the symptome of superficial fibular nerve injury?

A
  • loss of eversion.
  • A loss of sensation: the dorsum, the anterolateral aspect of the lower
    leg
37
Q

Mechanism of Sciatic nerve
injury?

A
  • Trauma - hip dislocation, acetabular fracture
  • Iatrogenic causes
38
Q

Functions of the sciatic nerve?

A
  • Motor functions:
    • Innervates the muscles of the
      posterior thigh (biceps femoris,
      semimembranosus and
      semitendinosus) and the hamstring
      portion of the adductor magnus
  • Sensory functions:
    • Indirectly (via its
      terminal branches) the skin of the lateral
      leg, heel, and both the dorsal and plantar
      surfaces of the foot.
39
Q

The symptoms of sciatic nerve injury?

A
  • foot drop
  • The pain can occasionally be exacerbated by internal rotation of the lower limb at the hip.
  • Atrophy of muscles, sensory deficit
40
Q

Piriformis syndrome?

A
  • compression of the sciatic
    nerve by the piriformis muscle.

Traumatology (3 decks)

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