Rehabilitation of Peripheral Nerve Injuries in Disasters and Conflicts

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Original Editors - Naomi O'Reilly

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

Introduction

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Immediate Emergency Care

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Emergency Medical Teams

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Common Nerve Injuries

Upper LImb

Nerve	Related Injuries	Muscle Affected	Motor Function	Sensation	Test
Spinal Accessory Nerve	Fracture Atlas or Hyoid Neck Trauma	Trapezius	Elevates Pectoral Girdle Retracts Scapula Depresses Shoulder Ipsilateral side flexion of neck		Posture Scapular Winging at Rest Assess Abduction Test Hand behind back and lift hand away from back
Long Thoracic Nerve	Sudden Scapular Depression Axillary Crutch Use	Serratus Anterior	Scapula Protraction Upward Scapular Rotation		Scapular Winging with Movement
Axillary Nerve	Most common peripheral nerve injury to affect the shoulder. Fracture Shoulder Dislocation Shoulder	Deltoid Teres Minor	Abduction from 15° Shoulder Extension Shoulder Flexion External Rotation Atrophy Deltoid - Flat Shoulder	Regimental Patch	Unable to Abduct Arm to 90 degrees Unable to maintain resisted abduction at 90 degrees
Suprascapular Nerve	Shoulder Fracture Clavicular Fracture Proximal Humeral Fracture	Infraspinatus Supraspinatus	Initial 15° Abduction External Rotation Atrophy Supraspinatus and/or Infraspinatus		Infraspinatus Test Suprascapular Nerve Stretch Test
Musculocutaneous Nerve	Isolated injury to the Musculocutaneous Nerve is rare Knife wound to Axilla	Biceps Brachii Brachialis Coracobrachialis	Elbow Flexion 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: Flexor Carpi Ulnaris Flexor Digitorum Profundus	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; Abductor Digiti Minimi Flexor Digiti Minimi Opponens Digiti Minimi Thenar Eminence; Adductor Pollicis Short Muscles; Lumbrical 3 & 4 Dorsal Interossei Palmar Interossei Palmaris Brevis	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 Triceps Brachii Anconeus             Extensor Indicis	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; Brachioradialis Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Supinator Extensor Digitorum Extensor Digiti Minimi Extensor Carpi Ulnaris Abductor Pollicis Longus Extensor Pollicis Longus Extensor Pollicis Brevis	Middle & Low Lesion; Loss Wrist Extension Loss Hand Extension Loss Radial Deviation Loss Thumb Extension Atrophy Forearm
Median Nerve	Supracondylar Humeral Fractures	Forearm; Pronator Teres Flexor Carpi Radialis Palmaris Longus Flexor Digitorum Superficialis Flexor Digitorum Profundus Flexor Pollicis Longus Pronator Quadratus	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 Lumbricals 1 & 2 Opponens Pollicis Abductor Pollicis Flexor Pollicis	Carpal Tunnel; Wasting of Thenar Eminence; Weakness Abductor Pollicis Brevis Loss of Opponens

Resources

Early Rehabilitation in Conflict and Disasters, Humanity and Inclusion

Rehabilitation in Sudden Onset Disasters, Humanity and Inclusion