Nerve Examination-leprosy 2

Nerves Examination

Department Dermato-venereologyFK-UNSRI/RS dr. Moh Hoesin

Palembang2008

Which nerves should you examine?

• N. Auricularis magnus• N. Ulnaris• N. Medianus• N. Radialis• N. Peroneus communis• N. Tibialis posterior• N. Trigeminus• N.. Fasialis

Is the nerve tender?

While you feel each nerve, look at the patient’s face to see if you are causing him pain

Remember that when you press very hard even a normal nerve will be painful

Is the nerve thickened?

While you feel each nerve, look at the patient’s face to see if you are causing him pain

Remember that when you press very hard even a normal nerve will be painful

N. Auricularis magnus

• Great auricular nerve is first visualized by turning the head to one side

• The nerve stretches across the sternomastoid muscle

• Once visualized the patiet is asked to turn the head against the resistance os examiner’s hand hed on the chin, the nerves is palpated

N. Auricularis Magnus Examination

N. Ulnaris

• Ulnar nerve lies above the olecranon posse• Feel the right ulnar nerve with left hand ang

left nerve wth right hand

N. Ulnaris Examination

N. Radialis

• Radial nerve is palpated in the radial groove

N. Radialis Examination

N. Radialis

N. Medianus

• The medianus nerve is palpated by flexing the elbow and the palpating deeply between he flexor tendon, at the wrist

N. Medianus

N. Peroneous communis

• Common peroneal nerve is felt at the neck of fibula on both sides.

• The patient is asked to sit on the chair relaxed while palpation

• It is felt two centimeters below the head of fibula

N.Peroneous Communis Examination

N. Tibialis Posterior

• Posterior tibial nerve is felt posterior and inferior to the medial malleolus

N. Tibialis Posterior

Lagophthalmos Facial nerve – branch to the eyelids

Ask the patients to close his eyes ang keep them lightlyclose as if sleeping

Lagophthalmos means paralysis of the eyelids so that they do not close completely

examination

Lagophthalmos

The patient is trying to close his eyes

Measure the gap between the eyelids. Here it is about 2 mm

Testing for anaesthesia

There are two reasons for testing for anasthesia• To help with diagnosis and classification• To decide whether there is a risk of future

problems such as ulcers and other damage

Testing to help with diagnosis and classification

Where to testSkin lesions- hands, feet, legs

What to use Thin points of cotton wool

Testing to decide risk of future damage

Where to test- Palms and soles of feet- Cornea

What to use The points of pencil, piece of grass,a nylon monofilament (10 g)

GANGGUAN FUNGSI SYARAF TEPI

SENSORIK MOTORIK OTONOM

ANESTHESI / MATI RASA

KELEMAHAN OTOT

GG KEL MINYAK, KERINGAT,CIRC DARAH

TANGAN KAKI MATIRASA

CORNEA MATA MATIRASA

REFLEK KEDIP (-)

JARI, TANGAN, KAKI LEMAH / LUMPUH

KULIT KERING / PECAH-PECAH

LUKA

MUTILASI / ABSORBSI

INFEKSI

BUTA

LAGOPTHALMUS

TANGAN/KAKI KITING, BENGKOK

MUTILASI / ABSORBSI

BUTA

LUKA/ULCUS

INFEKSI

INFEKSI

Pemeriksaan fungsi saraf Facialis

Pemeriksaan raba Saraf Ulnaris

Pemeriksaan fungsi motorikSaraf Medianus

Pemeriksaan fungsi motorik

Saraf Ulnaris

Pemeriksaan fungsi motorikSaraf Radialis

Pemeriksaan Rasa Rabatangan (fungsi sensoris saraf ulnaris

dan medianus)

Pemeriksaan perabaan saraf Peroneus Communis

Pemeriksaan perabaan Saraf Tibialis Posterior

Pemeriksaan fungsisaraf Peroneus Communis

Pemeriksaan fungsisensoris saraf Tibialis Posterior

• Adakah Nodul ulcerasi ?• Adakah bercak aktif / bengkak

didaerah syaraf tepi ?• Adakah nyeri tekan pada syaraf

tepi ?• Apakah kekuatan otot / rasa

raba berkurang dalam 6 bulan terakhir ?

• Adakah Lagopthalmus yang baru terjadi dalam 6 bulan terakhir ?

Bila ada satu saja Jawaban “ Ya “MAKABerarti reaksi berat perlu Diberi prednison.

HASIL PEMERIKSAAN P O D

Bila ada jawaban “ya” dalam kesimpulan hasil pemeriksaan POD :

• Kesimpulan pemeriksaan : REAKSI BERAT

• Berikan PREDNISON tablet sesuai prosedur.

• Evaluasi tiap 2 minggu (periksa ulang POD)

• Bila reaksi berat terjadi dalam masa pengobatan,

MDT tidak boleh dihentikan

• Bagi penderita reaksi berat setelah RFT, MDT tidak perlu diulang