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			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	Weak Scapula Protraction Weak 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	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	Shoulder Fracture Clavicular Fracture Proximal Humeral Fracture	Infraspinatus Supraspinatus	Loss of initial 15°Abduction Weak 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	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: Flexor Carpi Ulnaris Flexor Digitorum Profundus 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	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 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	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 Partial Claw Hand
Radial Nerve	Humeral Fracture Elbow Fractures Elbow Wounds	Arm Triceps Brachii Anconeus             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 Extensor Indicis	High Lesion; Loss Elbow Extension Loss Wrist Extension Loss Hand Extension Loss Radial Deviation Atrophy Forearm Middle & Low Lesion; Loss Wrist Extension Loss Hand Extension Loss Radial Deviation Loss Thumb Extension 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 Poor Grip Strength
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 Low Lesion; Long Flexors Unaffected Loss of Opponens Thenar Muscle Wasting Carpal Tunnel; Wasting of Thenar Eminence; Weakness Abductor Pollicis Brevis Loss of Opponens		Ok Test Pinch Test
		Hand; LOAF Lumbricals 1 & 2 Opponens Pollicis Abductor Pollicis Flexor Pollicis

Resources

Early Rehabilitation in Conflict and Disasters, Humanity and Inclusion

Rehabilitation in Sudden Onset Disasters, Humanity and Inclusion