Prof Saleh WaslAllah Alharby

PERIPHERAL NERVES INJURIESPERIPHERAL NERVES INJURIESDR SALEH W ALHARBYDR SALEH W ALHARBY

Professor ProfessorCollege of medicineCollege of medicineDept of OrthopedicsDept of Orthopedics

King Saud UnivKing Saud Univwww.ksu.edu.sa/DrSalehAlharbywww.ksu.edu.sa/DrSalehAlharby

Dr Saleh WaslAllah Alharby

www.ksu.edu.sa/DrSalehAlharby

• WHAT IS A PERIPHERAL NERVE?WHAT IS A PERIPHERAL NERVE?

PERIPHERAL NERVE PERIPHERAL NERVE INJURIESINJURIES

• WHAT ARE THE FEATURES OF A WHAT ARE THE FEATURES OF A PERIPHERAL NERVE?PERIPHERAL NERVE?

– RELATES PERIPHERY AND SPINAL CORD.RELATES PERIPHERY AND SPINAL CORD.– MIXED (SENSORY AND MOTOR).MIXED (SENSORY AND MOTOR).– REGENERATES.REGENERATES.

OUTLINEOUTLINE

• DEFINITION.DEFINITION.

• TYPES OF NERVE INJURIES.TYPES OF NERVE INJURIES.

• FATE (pathophysiology) AND REHABILITATION.FATE (pathophysiology) AND REHABILITATION.

• ETIOLOGY.ETIOLOGY.

• PRESENTATION.PRESENTATION.

• DIAGNOSIS.DIAGNOSIS.

• CLINICAL EXAMPLES:CLINICAL EXAMPLES: (ERB’S,CARPAL TUNNEL,RADIAL,ULNAR,SCIATIC AND PERONEAL (ERB’S,CARPAL TUNNEL,RADIAL,ULNAR,SCIATIC AND PERONEAL

N.)N.)

DEFINITIONDEFINITION

Partial or complete interruption of normal Partial or complete interruption of normal physiology of the nerve.physiology of the nerve.

NERVE CONDUCTION IS AFFECTED.NERVE CONDUCTION IS AFFECTED.

TYPES OF NERVE INJURIESTYPES OF NERVE INJURIES

1-NEUROPRAXIA1-NEUROPRAXIAREVERSIBLE FAILURE OF PROPAGATION OF THE REVERSIBLE FAILURE OF PROPAGATION OF THE

ELECTRICAL ELECTRICAL IMPULSE ACROSS THE AFFECTED NERVE IMPULSE ACROSS THE AFFECTED NERVE SEGMENT WITHOUT SEGMENT WITHOUT ANATOMICAL DISTURBANCE OF THE ANATOMICAL DISTURBANCE OF THE NERVE. NERVE. HRS-DAYS.HRS-DAYS.

SATURDAY NIGHT PALSYSATURDAY NIGHT PALSY

HONEYMOONERS SYNDROMEHONEYMOONERS SYNDROME

WHEELCHAIR BOUND PERSONSWHEELCHAIR BOUND PERSONS

2-AXONOTMESIS2-AXONOTMESISCOMPLETE ABSENCE OF SENSORY AND MOTOR COMPLETE ABSENCE OF SENSORY AND MOTOR

ACTIVITIES. ACTIVITIES. DAYS-WEEKSDAYS-WEEKS

AXONAL AND MYELIN SHEATH DAMAGEAXONAL AND MYELIN SHEATH DAMAGE

LOSS OF CELL BODY CONTINUITY TO ITS END LOSS OF CELL BODY CONTINUITY TO ITS END ORGAN.ORGAN.

ENDO,PERI AND EPINEURIUM ARE PRESERVED.ENDO,PERI AND EPINEURIUM ARE PRESERVED.

PROGNOSIS FOR RECOVERY IS GOOD.PROGNOSIS FOR RECOVERY IS GOOD.

3-NEUROTMESIS3-NEUROTMESISCOMPLETE DISRUBTION OF ALL THE AXONS AND COMPLETE DISRUBTION OF ALL THE AXONS AND

SUPPORTING CONNECTIVE TISSUE STRUCTURES.SUPPORTING CONNECTIVE TISSUE STRUCTURES.

VERY POOR PROGNOSIS WITHOUT SURGICAL VERY POOR PROGNOSIS WITHOUT SURGICAL REPAIR.REPAIR.

FATE AND REHABILITATIONFATE AND REHABILITATION

• WALLERIAN DEGENERATIONWALLERIAN DEGENERATION

1 MM PER DAY1 MM PER DAY

REHABILITATIONREHABILITATION

• PAIN CONTROL.PAIN CONTROL.• SPLINT. SPLINT. (AVOID PRESSURE SORES)(AVOID PRESSURE SORES)

• NERVE AND MUSCLE STIMULATION.NERVE AND MUSCLE STIMULATION.

• NEARBY JOINTS RANGE OF MOTION.NEARBY JOINTS RANGE OF MOTION.

• MONTHS ----- YEARS .MONTHS ----- YEARS .

ETIOLOGYETIOLOGY

• ACUTEACUTEFRACTUREFRACTUREWRONG POSTUREWRONG POSTURESURGERYSURGERYELECTRICAL BURNELECTRICAL BURN

• CHRONICCHRONICTIGHT NERVE PASSAGETIGHT NERVE PASSAGETUMORSTUMORS

PERSENTATIONPERSENTATION

• PAINPAIN• LOSS OF SENSATIONLOSS OF SENSATION• LOSS OF MOTIONLOSS OF MOTION• LOSS OF POWERLOSS OF POWER• LOSS OF REFLEXESLOSS OF REFLEXES• WASTINGWASTING• TROPHIC CHANGES TROPHIC CHANGES

(skin,sc,neurovascular,bones,muscles)(skin,sc,neurovascular,bones,muscles)

• CONTRACTURESCONTRACTURES

DIAGNOSISDIAGNOSIS

• PAINPAIN• LOSS OF SENSATIONLOSS OF SENSATION• LOSS OF MOTIONLOSS OF MOTION• LOSS OF POWERLOSS OF POWER• LOSS OF REFLEXESLOSS OF REFLEXES• WASTINGWASTING• TROPHIC CHANGES TROPHIC CHANGES

(skin,sc,neurovascular,bones,muscles)(skin,sc,neurovascular,bones,muscles)

• CONTRACTURESCONTRACTURES

DIAGNOSTIC AIDSDIAGNOSTIC AIDS

• X-RAYX-RAY

• EMGEMG

• NCSNCS

• MRIMRI

CLINICAL EXAMPLESCLINICAL EXAMPLES

• ERB’ PALSYERB’ PALSY

• CARPAL TUNNEL SYNDROME(MEDIAN CARPAL TUNNEL SYNDROME(MEDIAN NV)NV)

• RADIAL NERVE INJURYRADIAL NERVE INJURY

• ULNAR NERVE INJURYULNAR NERVE INJURY

• SCIATIC NERVE INJURYSCIATIC NERVE INJURY

• LATERAL POPLITEAL NERVE INJURYLATERAL POPLITEAL NERVE INJURYDr Saleh WaslAllah Alharby

ERB’S PALSYERB’S PALSY

• BIRTH INJURY (DIFFICULT LABOUR)BIRTH INJURY (DIFFICULT LABOUR)

• TRACTION ON NERVE ROOTS C5-6TRACTION ON NERVE ROOTS C5-6

• STRETCH-RUPTURE-AVULSIONSTRETCH-RUPTURE-AVULSION

• UPPER LIMB IN EXTENSIONUPPER LIMB IN EXTENSION

• MOTHER NOTICE NO MOTIONMOTHER NOTICE NO MOTION

• 90% GOOD RECOVERY90% GOOD RECOVERY

• ROLE OF SURGERY AFTER 3 MONTHSROLE OF SURGERY AFTER 3 MONTHS

• REMEMBER PROPER REHABILITATIONREMEMBER PROPER REHABILITATIONDr Saleh WaslAllah Alharby

CARPAL TUNNEL SYNDROMECARPAL TUNNEL SYNDROME

• MEDIAN NERVE ENTRAPMENT BY MEDIAN NERVE ENTRAPMENT BY FLEXOR RETINACULUM (TVS CARPAL FLEXOR RETINACULUM (TVS CARPAL LIGAMENT)LIGAMENT)

• PAIN,NUMBNESS,NIGHTPAIN,NUMBNESS,NIGHT

• MANUAL WORKERSMANUAL WORKERS

• DIAGNOSISDIAGNOSIS

• CONS RxCONS Rx

• SURGERYSURGERYDr Saleh WaslAllah Alharby

RADIAL NERVE INJURYRADIAL NERVE INJURY

ULNAR NERVE INJURYULNAR NERVE INJURY

SCIATIC NERVE INJURYSCIATIC NERVE INJURY

PERONEAL NERVE INJURY (LPN)PERONEAL NERVE INJURY (LPN)

• FOOT DROPFOOT DROP

• TIGHT POPTIGHT POP

• SKELETAL TRACTIONSKELETAL TRACTION

• DIRECT INJURY (RARE)DIRECT INJURY (RARE)

• DYNAMIC SPLINTDYNAMIC SPLINT

QUIZQUIZ

• Axon degeneration occurs from mild compression Axon degeneration occurs from mild compression injuryinjury

• The prognosis for Neuropraxia is poorThe prognosis for Neuropraxia is poor• Axonotmesis is generally caused from separation of Axonotmesis is generally caused from separation of

the cell body from the neuronthe cell body from the neuron • Wallerian Degeneration typically does not occur in Wallerian Degeneration typically does not occur in

Neuropraxic injury Neuropraxic injury • Surgical reconstruction is necessary in NeurotmesisSurgical reconstruction is necessary in Neurotmesis

• Wallerian Degeneration does not occur in NeurotmesisWallerian Degeneration does not occur in Neurotmesis • A ligamentous structure can cause NeuropraxiaA ligamentous structure can cause Neuropraxia

THANK YOUTHANK YOU

Prof Saleh WaslAllah Alharby

Documents

Manal Saleh - globalgap

saleh & ndubisi

Refuting Evolution - Dr Saleh as-Saleh

Al-qadaa Wal Qadar - Sheikh Saleh as-Saleh

Complaint: Reza Saleh, Defendant, and Amir Saleh, Relief Defendant

Suma k Saleh

Dr Saleh WaslAllah Alharby ksu.sa/DrSalehAlharby

Saleh presentation

Radwa Saleh - Resume

FACULTY FULL NAME: Nagla Saleh AL-Saleh - Imam ... FULL NAME: Nagla Saleh AL-Saleh POSITION: Assistant Professor Personal Data Nationality | Saudi Date of Birth | May, 09, 1982, AL-Khobar

119 Saleh Tourism

Saleh Al-Ojairi

X-RAY REVISION YOU WILL SEE A SLIDE TRY TO MAKE YOUR OWN COMMENT, THEN MOVE TO NEXT SLIDE FOR ANSWER OR COMMENT. Dr Saleh W Alharby alharby@ksu.edu..sa

Nagla Saleh Al-Saleh - Imam Abdulrahman Bin Faisal … Saleh Al-Saleh Personal Data Nationality | Saudi Date of Birth | May, 09, 1982, AL-Khobar Department | Community Health Department

By: Tahseen Saleh

Story Of Saleh

Tawheed for Childrenfor Children Dr. Saleh AsDr. Saleh …thmsadaqagroup.org/TawheedforKidsPartTwo.pdf · 1 Tawheed for Childrenfor Children Dr. Saleh AsDr. Saleh As----SalehSaleh

Dr Saleh WaslAllah Alharby

Saleh Alresheed 2008

342 PHYS - Dr. S.Al Saleh 1 Dr.Salwa Al Saleh Salwams@ksu.edu.sa