Rehabilitation of Peripheral Nerve Injuries in Disasters and Conflicts: Difference between revisions
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== Introduction == | == Introduction == | ||
Peripheral nerves can sustain injury from numerous causes including traumatic injuries, inherited causes, infections, metabolic problems (one of the most common causes is [[Diabetes|diabetes mellitus]]), exposure to toxins; tumours and iatrogenic causes.<ref>Mayo Clinic. Peripheral Neuropathy. Available from: https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061 (Last Accessed 24/03/2019)</ref> | |||
== Immediate Emergency Care == | == Immediate Emergency Care == | ||
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Add your content to this page here! | Add your content to this page here! | ||
== Common Nerve Injuries == | == Peripheral Nerve Injury Overview == | ||
The peripheral nervous system is comprised of three types of cells: neuronal cells, glial cells, and stromal cells. Peripheral nerves convey signals between the spinal cord and the rest of the body. Nerves are comprised of various combinations of motor, sensory, and autonomic neurons. Efferent neurons (motor and autonomic) receive signals through their dendrites from neurons of the central nervous system, primarily using the neurotransmitter acetylcholine among others. Afferent (sensory) neurons receive their signals through their dendrites from specialized cell types, such as Paccinian corpuscles for fine sensation and others. These signals are sent to the CNS to provide sensory information to the brain and possibly interneurons in the spinal cord when a reflex response is necessary1. | |||
A peripheral nerve injury can result in a minor injury or a fully severed nerve. Based on the type and amount of damage, nerve regeneration may or may not be possible. Peripheral nerve Injury treatment depends on the type of injury, symptoms and the amount of nerve injury sustained. | |||
== Classification of Peripheral Nerve Injuries == | |||
Classification systems provides a common language for medical and rehabilitation professionals to effectively discuss nerve pathophysiology. There are two commonly used classification systems in use for peripheral nerve injury; the Seddon Classification and the Sunderland Classification. | |||
Seddon was the first to classify nerve injuries into three categories; neurapraxia, axonotmesis, and neurotmesis, based on the presence of demyelination and the extent of damage to the axons and the connective tissues of the nerve. Sunderland later expanded on this initial classification to distinguish the extent of damage in the connective tissues. A Grade VI lesion was later introduced by McKennon and Dellon to denote combinations of Grade III-V injuries along a damaged nerve, although its usage has not been widely accepted | |||
{| width="800" border="1" cellpadding="1" cellspacing="1" | |||
|- | |||
! scope="col" | '''Seddon Classification''' | |||
!'''Sunderland Classification''' | |||
!'''McKennon & Dellon''' | |||
! scope="col" | '''Type of Injury''' | |||
|- | |||
| Neuropraxia | |||
|Grade I | |||
| | |||
|Local myelin damage usually secondary to compression | |||
|- | |||
| rowspan="3" |Axonotmesis | |||
|Grade II | |||
| | |||
|Axon severed but endoneurium intact (optimal circumstances for regeneration) | |||
|- | |||
|Grade III | |||
| | |||
| | |||
* Axon discontinuity, endoneurial tube discontinuity. | |||
* Perineurium and fascicular arrangement preserved | |||
|- | |||
|Grade IV | |||
| | |||
| | |||
* Loss of continuity of axons, endoneurial tubes, | |||
* Perineurium and fasciculi; epineurium intact | |||
|- | |||
|Neurotmesis | |||
|Grade V | |||
| | |||
| | |||
* Complete Nerve Transection | |||
* Total physiologic disruption of entire nerve trunk | |||
|- | |||
| | |||
| | |||
|Grade VI | |||
|Mixed levels of injury along the nerve | |||
|} | |||
== Common Peripheral Nerve Injuries == | |||
=== Upper | === Upper Limb === | ||
{| width="800" border="1" cellpadding="1" cellspacing="1" | {| width="800" border="1" cellpadding="1" cellspacing="1" | ||
|- | |- | ||
! scope="col" | '''Nerve''' | ! scope="col" |'''Nerve''' | ||
!'''Related Injuries''' | !'''Related Injuries''' | ||
! scope="col" | '''Muscle Affected''' | ! scope="col" |'''Muscle Affected''' | ||
!'''Motor Function''' | !'''Motor Function''' | ||
!'''Sensation''' | !'''Sensation''' | ||
! scope="col" | '''Test''' | ! scope="col" |'''Test''' | ||
|- | |- | ||
| '''[[Accessory Nerve Cranial Nerve 11|Spinal Accessory Nerve]]''' | |'''[[Accessory Nerve Cranial Nerve 11|Spinal Accessory Nerve]]''' | ||
| | | | ||
* Fracture Atlas or Hyoid | * Fracture Atlas or Hyoid | ||
* Neck Trauma | * Neck Trauma | ||
| | | | ||
* [[Trapezius]] | *[[Trapezius]] | ||
| | | | ||
* Elevates Pectoral Girdle<span class="reference" id="cite_ref-Moore_2-2"></span> | * Elevates Pectoral Girdle<span class="reference" id="cite_ref-Moore_2-2"></span> | ||
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<span class="reference" id="cite_ref-Moore_2-4"></span> | <span class="reference" id="cite_ref-Moore_2-4"></span> | ||
| | | | ||
| '''Posture''' | |'''Posture''' | ||
*[[Scapular Winging]] at Rest | |||
* [[Scapular Winging]] at Rest | |||
* Assess Abduction | * Assess Abduction | ||
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* Hand behind back and lift hand away from back | * Hand behind back and lift hand away from back | ||
|- | |- | ||
| '''[[Long Thoracic Nerve]]''' | |'''[[Long Thoracic Nerve]]''' | ||
| | | | ||
* Sudden Scapular Depression | * Sudden Scapular Depression | ||
* Axillary Crutch Use | * Axillary Crutch Use | ||
| | | | ||
* [[Serratus Anterior]] | *[[Serratus Anterior]] | ||
| | | | ||
* Scapula Protraction | * Scapula Protraction | ||
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| | | | ||
| | | | ||
* [[Scapular Winging]] with Movement | *[[Scapular Winging]] with Movement | ||
|- | |- | ||
| '''[[Axillary Nerve Injury|Axillary Nerve]]''' | |'''[[Axillary Nerve Injury|Axillary Nerve]]''' | ||
|Most common peripheral nerve injury to affect the shoulder. | |Most common peripheral nerve injury to affect the shoulder. | ||
* Fracture Shoulder | * Fracture Shoulder | ||
*[[Shoulder Dislocation|Dislocation Shoulder]] | *[[Shoulder Dislocation|Dislocation Shoulder]] | ||
| | | | ||
* [[Deltoid]] | *[[Deltoid]] | ||
* [[Teres Minor]] | *[[Teres Minor]] | ||
| | | | ||
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| | | | ||
* Shoulder Fracture | * Shoulder Fracture | ||
* [[Clavicular Fracture]] | *[[Clavicular Fracture]] | ||
* Proximal Humeral Fracture | * Proximal Humeral Fracture | ||
| | | | ||
* [[Infraspinatus]] | *[[Infraspinatus]] | ||
* [[Supraspinatus]] | *[[Supraspinatus]] | ||
| | | | ||
* Initial 15° Abduction | * Initial 15° Abduction | ||
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| | | | ||
| | | | ||
* [[Infraspinatus Test]] | *[[Infraspinatus Test]] | ||
* Suprascapular Nerve Stretch Test | * Suprascapular Nerve Stretch Test | ||
* | * | ||
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* Knife wound to Axilla | * Knife wound to Axilla | ||
| | | | ||
* [[Biceps Brachii]] | *[[Biceps Brachii]] | ||
* [[Brachialis]] | *[[Brachialis]] | ||
* [[Coracobrachialis Muscle|Coracobrachialis]] | *[[Coracobrachialis Muscle|Coracobrachialis]] | ||
| | | | ||
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* Laceration at Wrist | * Laceration at Wrist | ||
|'''Forearm:''' | |'''Forearm:''' | ||
*[[Flexor Carpi Ulnaris Muscle|Flexor Carpi Ulnaris]] | |||
* [[Flexor Carpi Ulnaris Muscle|Flexor Carpi Ulnaris]] | *[[Flexor Digitorum Profundus]] | ||
* [[Flexor Digitorum Profundus]] | |||
|'''High Lesion - Ulnar Paradox;''' | |'''High Lesion - Ulnar Paradox;''' | ||
* 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 | ||
* Paralysis 4<sup>th</sup> & 5<sup>th</sup> Finger at IP Joint; Straighter Fingers | * Paralysis 4<sup>th</sup> & 5<sup>th</sup> Finger at IP Joint; Straighter Fingers | ||
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* Dorsal 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 | * Inability to cross second and third finger | ||
* Poor Grasp and Release | * Poor Grasp and Release | ||
|- | |- | ||
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|'''Arm''' | |'''Arm''' | ||
*[[Triceps brachii|Triceps Brachii]] | *[[Triceps brachii|Triceps Brachii]] | ||
* [[Anconeus]] | *[[Anconeus]] | ||
*[[Extensor Indicis Proprius|Extensor Indicis]] | *[[Extensor Indicis Proprius|Extensor Indicis]] | ||
|'''High Lesion;''' | |'''High Lesion;''' | ||
* Loss Elbow Extension | * Loss Elbow Extension | ||
* Loss Wrist Extension | * Loss Wrist Extension |
Revision as of 20:02, 23 April 2022
Original Editors - Naomi O'Reilly
Top Contributors - Naomi O'Reilly, Tarina van der Stockt, Kim Jackson and Jess Bell
Introduction[edit | edit source]
Peripheral nerves can sustain injury from numerous causes including traumatic injuries, inherited causes, infections, metabolic problems (one of the most common causes is diabetes mellitus), exposure to toxins; tumours and iatrogenic causes.[1]
Immediate Emergency Care[edit | edit source]
Add your content to this page here!
Emergency Medical Teams[edit | edit source]
Add your content to this page here!
Peripheral Nerve Injury Overview[edit | edit source]
The peripheral nervous system is comprised of three types of cells: neuronal cells, glial cells, and stromal cells. Peripheral nerves convey signals between the spinal cord and the rest of the body. Nerves are comprised of various combinations of motor, sensory, and autonomic neurons. Efferent neurons (motor and autonomic) receive signals through their dendrites from neurons of the central nervous system, primarily using the neurotransmitter acetylcholine among others. Afferent (sensory) neurons receive their signals through their dendrites from specialized cell types, such as Paccinian corpuscles for fine sensation and others. These signals are sent to the CNS to provide sensory information to the brain and possibly interneurons in the spinal cord when a reflex response is necessary1.
A peripheral nerve injury can result in a minor injury or a fully severed nerve. Based on the type and amount of damage, nerve regeneration may or may not be possible. Peripheral nerve Injury treatment depends on the type of injury, symptoms and the amount of nerve injury sustained.
Classification of Peripheral Nerve Injuries[edit | edit source]
Classification systems provides a common language for medical and rehabilitation professionals to effectively discuss nerve pathophysiology. There are two commonly used classification systems in use for peripheral nerve injury; the Seddon Classification and the Sunderland Classification.
Seddon was the first to classify nerve injuries into three categories; neurapraxia, axonotmesis, and neurotmesis, based on the presence of demyelination and the extent of damage to the axons and the connective tissues of the nerve. Sunderland later expanded on this initial classification to distinguish the extent of damage in the connective tissues. A Grade VI lesion was later introduced by McKennon and Dellon to denote combinations of Grade III-V injuries along a damaged nerve, although its usage has not been widely accepted
Seddon Classification | Sunderland Classification | McKennon & Dellon | Type of Injury |
---|---|---|---|
Neuropraxia | Grade I | Local myelin damage usually secondary to compression | |
Axonotmesis | Grade II | Axon severed but endoneurium intact (optimal circumstances for regeneration) | |
Grade III |
| ||
Grade IV |
| ||
Neurotmesis | Grade V |
| |
Grade VI | Mixed levels of injury along the nerve |
Common Peripheral Nerve Injuries[edit | edit source]
Upper Limb[edit | edit source]
Nerve | Related Injuries | Muscle Affected | Motor Function | Sensation | Test |
---|---|---|---|---|---|
Spinal Accessory Nerve |
|
|
Posture
Test
| ||
Long Thoracic Nerve |
|
|
| ||
Axillary Nerve | Most common peripheral nerve injury to affect the shoulder.
|
|
|
| |
Suprascapular Nerve |
|
|
| ||
Musculocutaneous Nerve | Isolated injury to the Musculocutaneous Nerve is rare
|
|
|
| |
Ulnar Nerve | At risk of Injury at Medial Epicondyle, in Cubital Tunnel, or at the Wrist;
|
Forearm: | High Lesion - Ulnar Paradox;
|
|
|
Hand
Hypothenar Eminence; Thenar Eminence; Short Muscles; |
Low Lesion - Partial Claw Hand;
|
| |||
Radial Nerve |
|
Arm | High Lesion;
|
No Sensory Involvement if Posterior Interosseous Branch is Damaged Alone
|
|
Forearm; | Middle & Low Lesion;
| ||||
Median Nerve | Forearm; | High Lesion;
|
|
| |
Low Lesion;
| |||||
Hand; LOAF | Carpal Tunnel;
|
Lower Limb[edit | edit source]
Nerve | Related Injuries | Muscle Affected | Motor Function | Sensation | Test |
---|---|---|---|---|---|
Gluteal Nerve |
|
|
|||
Femoral Nerve |
|
|
|
| |
Tibial Nerve |
|
|
| ||
Peroneal Nerve |
|
|
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]
- ↑ Mayo Clinic. Peripheral Neuropathy. Available from: https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061 (Last Accessed 24/03/2019)