Rehabilitation of Peripheral Nerve Injuries in Disasters and Conflicts: Difference between revisions

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* Unable to Flex Elbow
* Unable to Flex Elbow
|-
|-
|'''[[Ulnar Nerve]]'''
| rowspan="2" |'''[[Ulnar Nerve]]'''
|At risk of Injury at Medial Epicondyle, in Cubital Tunnel, or at the Wrist;
| rowspan="2" |At risk of Injury at Medial Epicondyle, in Cubital Tunnel, or at the Wrist;


* Fracture Elbow
* Fracture Elbow
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* [[Flexor Carpi Ulnaris Muscle|Flexor Carpi Ulnaris]]
* [[Flexor Carpi Ulnaris Muscle|Flexor Carpi Ulnaris]]
* [[Flexor Digitorum Profundus]]
* [[Flexor Digitorum Profundus]]
'''Hand'''
'''Hypothenar Eminence;'''
* [[Abductor Digiti Minimi (Hand)|Abductor Digiti Minimi]]
* [[Flexor Digiti Minimi Brevis|Flexor Digiti Minimi]]
* [[Opponens Digiti Minimi]]
'''Thenar Eminence;'''
* [[Adductor Pollicis]]
'''Short Muscles;'''
* [[Lumbricals of the Hand|Lumbrical 3 & 4]]
* [[Dorsal Interossei of the Hand|Dorsal Interossei]]
* [[Palmar Interossei]]
* [[Palmaris Brevis]]
|'''High Lesion - Ulnar Paradox;'''
|'''High Lesion - Ulnar Paradox;'''


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* Wasting Hypothenar Eminence
* Wasting Hypothenar Eminence
* Wasting Interossei
* Wasting Interossei
| rowspan="2" |
* Palmar Surface of 5<sup>th</sup> & ½ 4<sup>th</sup> Digit
* Dorsal Surface of 5<sup>th</sup> & ½ 4<sup>th</sup> Digit
|
* Inability to cross second and third finger
* Poor Grasp and Release
|-
|'''Hand'''


'''Low Lesion - Partial Claw Hand;'''
'''Hypothenar Eminence;'''
 
*[[Abductor Digiti Minimi (Hand)|Abductor Digiti Minimi]]
*[[Flexor Digiti Minimi Brevis|Flexor Digiti Minimi]]
*[[Opponens Digiti Minimi]]
 
'''Thenar Eminence;'''
 
*[[Adductor Pollicis]]
 
'''Short Muscles;'''


*[[Lumbricals of the Hand|Lumbrical 3 & 4]]
*[[Dorsal Interossei of the Hand|Dorsal Interossei]]
*[[Palmar Interossei]]
*[[Palmaris Brevis]]
|'''Low Lesion - Partial Claw Hand;'''
* Hyperextension 4<sup>th</sup> & 5<sup>th</sup> Finger at MCP Joint
* Hyperextension 4<sup>th</sup> & 5<sup>th</sup> Finger at MCP Joint
* Flexion 4<sup>th</sup> & 5<sup>th</sup> Finger at IP Joint
* Flexion 4<sup>th</sup> & 5<sup>th</sup> Finger at IP Joint
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* Wasting Interossei
* Wasting Interossei
|
|
* Palmar Surface of 5<sup>th</sup> & ½ 4<sup>th</sup> Digit
* Inability to cross second and third finger
* Dorsal Surface of 5<sup>th</sup> & ½ 4<sup>th</sup> Digit
|
* Inability to cross second and third finger  
* Poor Grasp and Release
* Poor Grasp and Release
* Partial Claw Hand
* Partial Claw Hand
|-
|-
|'''[[Radial Nerve]]'''
| rowspan="2" |'''[[Radial Nerve]]'''
|
| rowspan="2" |
* Humeral Fracture
* Humeral Fracture
* Elbow Fractures
* Elbow Fractures
* Elbow Wounds
* Elbow Wounds
|'''Arm'''
|'''Arm'''
*[[Triceps brachii|Triceps Brachii]]
* [[Anconeus]]            


* [[Triceps brachii|Triceps Brachii]]
*[[Extensor Indicis Proprius|Extensor Indicis]]
* [[Anconeus]]            
 
'''Forearm;'''
 
* [[Brachioradialis]]
* Extensor Carpi Radialis Longus
* [[Extensor Carpi Radialis Brevis]]
* [[Supinator]]
* [[Extensor Digitorum Communis|Extensor Digitorum]]
* [[Extensor Digiti Minimi]]
* [[Extensor Carpi Ulnaris]]
* [[Abductor pollicis longus|Abductor Pollicis Longus]]
* [[Extensor Pollicis Longus]]
* [[Extensor Pollicis Brevis]]
* [[Extensor Indicis Proprius|Extensor Indicis]]
|'''High Lesion;'''
|'''High Lesion;'''


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* Loss Radial Deviation
* Loss Radial Deviation
* Atrophy Forearm
* Atrophy Forearm
| rowspan="2" |No Sensory Involvement if Posterior Interosseous Branch is Damaged Alone


'''Middle & Low Lesion;'''
* 1<sup>st</sup> Webspace;


* Dorsum Aspect Hand from 1<sup>st</sup> to ½ 4<sup>th</sup> Digit
| rowspan="2" |
* Wrist Drop Present
|-
|'''Forearm;'''
*[[Brachioradialis]]
* Extensor Carpi Radialis Longus
*[[Extensor Carpi Radialis Brevis]]
*[[Supinator]]
*[[Extensor Digitorum Communis|Extensor Digitorum]]
*[[Extensor Digiti Minimi]]
*[[Extensor Carpi Ulnaris]]
*[[Abductor pollicis longus|Abductor Pollicis Longus]]
*[[Extensor Pollicis Longus]]
*[[Extensor Pollicis Brevis]]
*
|'''Middle & Low Lesion;'''
* Loss Wrist Extension
* Loss Wrist Extension
* Loss Hand Extension
* Loss Hand Extension
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* Loss Thumb Extension
* Loss Thumb Extension
* Atrophy Forearm
* Atrophy Forearm
|No Sensory Involvement if Posterior Interosseous Branch is Damaged Alone
* 1<sup>st</sup> Webspace;
* Dorsum Aspect Hand from 1<sup>st</sup> to ½ 4<sup>th</sup> Digit
|
* Wrist Drop Present
* Poor Grip Strength
|-
|-
| rowspan="2" |'''[[Median Nerve]]'''
| rowspan="3" |'''[[Median Nerve]]'''
| rowspan="2" |
| rowspan="3" |
* [[Supracondylar humeral fracture|Supracondylar Humeral Fractures]]
*[[Supracondylar humeral fracture|Supracondylar Humeral Fractures]]
|'''Forearm;'''
| rowspan="2" |'''Forearm;'''
* [[Pronator Teres]]
*[[Pronator Teres]]
* [[Flexor Carpi Radialis]]
*[[Flexor Carpi Radialis]]
* [[Palmaris Longus]]
*[[Palmaris Longus]]


* [[Flexor Digitorum Superficialis]]
*[[Flexor Digitorum Superficialis]]
 
* [[Flexor Digitorum Profundus]]
* [[Flexor Pollicis Longus]]
* [[Pronator Quadratus]]
| rowspan="2" |'''High Lesion;'''


*[[Flexor Digitorum Profundus]]
*[[Flexor Pollicis Longus]]
*[[Pronator Quadratus]]
|'''High Lesion;'''
* Loss Wrist Flexion
* Loss Wrist Flexion
* Loss of Opponens
* Loss of Opponens
* Loss of Ulnar Deviation
* Loss of Ulnar Deviation
* Wasting of Thenar Eminence
* Wasting of Thenar Eminence
'''Low Lesion;'''
| rowspan="3" |
* Palmar Aspect 1<sup>st</sup> - ½ 4<sup>th</sup> Ring Finger
| rowspan="3" |
* Ok Test
* Pinch Test
|-
|'''Low Lesion;'''
* Long Flexors Unaffected
* Long Flexors Unaffected
* Loss of Opponens
* Loss of Opponens
* Thenar Muscle Wasting
* Thenar Muscle Wasting
 
|-
'''Carpal Tunnel;'''
|'''Hand; LOAF'''
 
*[[Lumbricals of the Hand|'''L'''umbricals]] 1 & 2
*[[Opponens polisis|'''O'''pponens Pollicis]]
*[[Abductor Pollicis Brevis|'''A'''bductor Pollicis]]
*[[Flexor Pollicis Brevis|'''F'''lexor Pollicis]]
|'''Carpal Tunnel;'''
* Wasting of Thenar Eminence;
* Wasting of Thenar Eminence;
* Weakness Abductor Pollicis Brevis
* Weakness Abductor Pollicis Brevis
* Loss of Opponens
* Loss of Opponens
| rowspan="2" |
| rowspan="2" |
* Ok Test
* Pinch Test
|-
|'''Hand; LOAF'''
* [[Lumbricals of the Hand|'''L'''umbricals]] 1 & 2
* [[Opponens polisis|'''O'''pponens Pollicis]]
* [[Abductor Pollicis Brevis|'''A'''bductor Pollicis]]
* [[Flexor Pollicis Brevis|'''F'''lexor Pollicis]]
|-
|-
|}
|}

Revision as of 23:30, 22 April 2022

Welcome to Rehabilitation in Disaster and Conflict Situations Content Development Project. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!! If you would like to get involved in this project and earn accreditation for your contributions, please get in touch!

Original Editors - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Tarina van der Stockt, Kim Jackson and Jess Bell      

Introduction[edit | edit source]

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Immediate Emergency Care[edit | edit source]

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Emergency Medical Teams[edit | edit source]

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Common Nerve Injuries[edit | edit source]

Upper LImb[edit | edit source]

Nerve Related Injuries Muscle Affected Motor Function Sensation Test
Spinal Accessory Nerve
  • Fracture Atlas or Hyoid
  • Neck Trauma
 Posture

Test

  • Hand behind back and lift hand away from back
Long Thoracic Nerve
  • Sudden Scapular Depression
  • Axillary Crutch Use
  • Weak Scapula Protraction
  • Weak Upward Scapular Rotation
Axillary Nerve Most common peripheral nerve injury to affect the shoulder.
  • Loss Abduction from 15°
  • Weakness Extension
  • Weakness Flexion
  • Weakness Rotation
  • Atrophy Deltoid - Flat Shoulder
  • Regimental Patch
  • Unable to Abduct Arm to 90 degrees
  • Unable to maintain resisted abduction at 90 degrees
Suprascapular Nerve
  • Loss of initial 15°Abduction
  • Weak External Rotation
  • Atrophy Supraspinatus and/or Infraspinatus
Musculocutaneous Nerve Isolated injury to the Musculocutaneous Nerve is rare
  • Knife wound to Axilla
  • Weak Elbow Flexion
  • Weak Supination
  • Weak or Absent Biceps Tendon Reflex
  • Atrophy Anterior Compartment Arm
  • Lateral and Volar Aspect of  the Forearm
  • Unable to Flex Elbow
Ulnar Nerve At risk of Injury at Medial Epicondyle, in Cubital Tunnel, or at the Wrist;
  • Fracture Elbow
  • Dislocation Elbow
  • Laceration at Wrist
 Forearm: High Lesion - Ulnar Paradox;
  • Hyperextension 4th & 5th Finger at MCP Joint
  • Paralysis 4th & 5th Finger at IP Joint; Straighter Fingers
  • Loss Ulnar Deviation
  • Loss of FCU Tendon on Ulna Flexion
  • Loss Interossei Function
  • Loss Thumb Adduction
  • Wasting Hypothenar Eminence
  • Wasting Interossei
  • Palmar Surface of 5th & ½ 4th Digit
  • Dorsal Surface of 5th & ½ 4th Digit
  • Inability to cross second and third finger
  • Poor Grasp and Release
Hand

Hypothenar Eminence;

Thenar Eminence;

Short Muscles;

Low Lesion - Partial Claw Hand;
  • Hyperextension 4th & 5th Finger at MCP Joint
  • Flexion 4th & 5th Finger at IP Joint
  • Loss Interossei Function
  • Loss Thumb Adduction
  • Wasting Hypothenar Eminence
  • Wasting Interossei
  • Inability to cross second and third finger
  • Poor Grasp and Release
  • Partial Claw Hand
Radial Nerve
  • Humeral Fracture
  • Elbow Fractures
  • Elbow Wounds
 Arm High Lesion;
  • Loss Elbow Extension
  • Loss Wrist Extension
  • Loss Hand Extension
  • Loss Radial Deviation
  • Atrophy Forearm
 No Sensory Involvement if Posterior Interosseous Branch is Damaged Alone
  • 1st Webspace;
  • Dorsum Aspect Hand from 1st to ½ 4th Digit
  • Wrist Drop Present
Forearm; Middle & Low Lesion;
  • Loss Wrist Extension
  • Loss Hand Extension
  • Loss Radial Deviation
  • Loss Thumb Extension
  • Atrophy Forearm
Median Nerve Forearm; High Lesion;
  • Loss Wrist Flexion
  • Loss of Opponens
  • Loss of Ulnar Deviation
  • Wasting of Thenar Eminence
  • Palmar Aspect 1st - ½ 4th Ring Finger
  • Ok Test
  • Pinch Test
Low Lesion;
  • Long Flexors Unaffected
  • Loss of Opponens
  • Thenar Muscle Wasting
Hand; LOAF Carpal Tunnel;
  • Wasting of Thenar Eminence;
  • Weakness Abductor Pollicis Brevis
  • Loss of Opponens

Resources[edit | edit source]

Early Rehabilitation in Conflict and Disasters, Humanity and Inclusion

Rehabilitation in Sudden Onset Disasters, Humanity and Inclusion

References [edit | edit source]

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