Index

A forearm, superficial radial and lateral cutaneous Abdomen and pelvis, 270–271 of, 8, 18 sympathetic system, 36 hand, median and ulnar nerves in, 17 Ablation, central nervous system, 557–558 median , 16 Acromegaly, 488 musculocutaneous nerve, 14 Action potential, ion channels, 56, 57 phrenic nerve, course of, 9 Adult radial nerve, 14 cutaneous sensation, recovery of, 130 right axilla and arm, 12 traumatic brachial plexopathy, 214 suprascapular and circumflex nerves, 13 Afferent autonomic pathways, 37 suprascapular nerves, 13 Ageing, peripheral nerve fibres changes, 59–61 trunks and cords, 7 Alcohol, iatrogenous , 487 ulnar nerve, 16 Allodynia, 529 Anterior tarsal tunnel syndrome, 220 Allografts, large gaps repair, 125–126 Arterial thoracic outlet syndrome, 277–279 Amputation Articaine, 503 limbs, 629 Atrophy, of foot, 110 reconstruction, 601–602 Autonomic nerve fibres, sweat glands, 65 revascularisation Autonomic nervous system axillary artery, rupture, 337, 338 afferent autonomic pathways, 37 brachial plexus, 333–334 efferent and afferent paths, 33 closed infraclavicular lesion, 334–339 parasympathetic nervous system, 36 incomplete avulsion , 336 sympathetic system median and ulnar nerves, 338 abdomen and pelvis, 36 patterns, 335 cervico thoracic (stellate) ganglion, 34 suprascapular and circumflex nerves, 339 in chest and abdomen, 35 Anatomy Avulsed ventral root autonomic nervous system, 2 (see also Autonomic reinnervation, 399 nervous system) repair, 410–411 cervical nerves, from spinal cord, 1 Avulsion lesion, spinal nerves repair cranial and spinal nerves (see also Cranial nerves; Spinal nerves) abdomen and pelvis, 270–271 brainstem and cervical cord, laminectomy, 4 anterolateral transvertebral approach, 262 division of, 2 brachial plexus, infraclavicular part of, 265 hemilaminectomy, 3 circumflex nerve, 266 origin of roots, 2 endoscopic transforaminal approach, 262 spine and spinal cord, 3 lateral approach, 262–264 musculo skeletal injury, nerves risk, 37–40 median nerves in, 266–269 Ankle plantar nerves and tibial nerve, 273, 275 equino-varus deformity of, 573 posterior interosseous nerve, 267, 269 eversion, 182 radial nerve, 266–267 foot orthosis, 596 sciatic nerve, 271–272 and heel, lumbar and sacral anterior primary rami, 30 spinal accessory nerve, 264–265 schwannoma, 539 suprascapular nerve, 265 Anterior horn cell disorders, 224 tibial and common peroneal nerves, 272–274 Anterior interosseous nerve syndrome, 208 ulnar nerves in, 266, 269–270 Anterior primary rami, of spinal nerves Axilla brachial plexus, 7, 10, 11 medial cord rupture, 153 cervical plexus, 8, 9 reversed vein grafting in, 242 circumflex (axillary) nerve, 13 Axillary (circumflex) nerve, upper limb neuropathies, 213 dermatomes distribution, upper limb, 12 , 118, 119 elbow, 15 Axonal transport, peripheral nerve fibres, 57

R. Birch, Surgical Disorders of the Peripheral Nerves, DOI: 10.1007/978-1-84882-108-8, © Springer-Verlag London Limited 2011 631 632 Index

Axonotmesis neurophysiological investigations (NPI) and neurotmesis outcome, electrodiagnostic grade, 449 focal mechanical , classification of, 82 pre-operative NPI investigations, 450–452 hour glass constriction of, 82 operation peripheral nerve injuries, 204 incomplete lesion, 454 Axoplasm, 43 indications for, 453–454 intra operative conduction studies, 455 B , evolution of, 454 Bilateral lesion post-operative care, 456–457 penetrating missile injuries, 332 repair, methods of, 456 repair, preganglionic injury, 407–409 ruptured C5 repair, with avulsion, 457 Biopsy, 243–244 recovery, in complete lesion Birth lesions of brachial plexus (BLBP), 217–218, 611–612 elbow and hand, 445 deformities evolution of, 446 biceps pseudotumor, 463 group 4 lesion, 446 C7 and C8, poor recovery for, 467 outcome, 447 clavicle and scapula shortening, 464 spinal nerve in elbow and forearm, 478–479 central affect, 431–432 flexor origin, proximal advancement of, 467 types of, 430, 431 injuries inflicted during, 463 study methods limb, denervation of, 464 C5, C6 and C7, 432 persisting muscular imbalance, 464–465 elbow, flexion and extension of, 434 shoulder dislocation, closed manipulation of, 466 green chart, 438–440 supination, 478–479 group 4 lesion, 434 electrodiagnostic findings, clinical interpretation of, 449 hand function, analysis of, 434 epidemiology inferior scapulo humeral angles, cocontraction bilateral lesion, from breech delivery, 440 and contracture, 436 causation, 437 Klumpke’s lesion, 434 incidence, 436–437 limb growth, 434–435 Mallet score, 444 Mallet chart, 435 natural history, 441 Narakas classification, 432–433 outcome of, 441 records, 432 ranges of active movement in, 445 risk factor chart, 432, 433 risk factors, 437–438, 440–444 scoring system for, 437 shoulder and of forearm rotation, ranges of movement, 443 serratus anterior paralysis, breech delivery, 436 untreated complex subluxation in, pain, 442, 444 shoulder, function of, 433–434, 436 gleno-humeral joint, posterior subluxation and wrist and hand, 434 dislocation (PS/PD) treatment, 447–448 active range of movement, 473 Bleeding, control, 233–234 AP and axial radiographs, after glenoplasty, 476 Blood supply, peripheral nerve fibres course to recovery, after relocation, 474–475 neck, resin cast of, 59 diagnosis and classification, 469–470 segmental medullary (radicular) arteries and anterior incidence of, 472 spinal artery, 60 inferior scapulo-humeral angle, fixed contracture of, 478 spinal cord and cauda equina, dorsal vessels, 58 lateral rotation osteotomy, shoulder dislocation, 471 Bone and muscle transfer, reconstruction, 601 medial rotation contracture, 470–471 Brachial plexus radiological and operative findings in, 476 amputation revascularisation, 333–334 reduction, anterior approach, 472 anterior primary rami, 7, 10, 11 secondary deformities, onset and progression of, 467–469 blood supply, 379–380 shoulder function, 477 BLPP, 611–612 group 4 lesion, spontaneous recovery in, 429 complete lesion, 621 imaging, 453 cranial nerves nerve operations, 453 cervical and, 9 afferent function, method of repair, 459 excision of clavicles, 10 breech delivery, 461 and great vessels, 11 C5 and 6 rupture, C7, C8 and T1 avulsion, 462 left, 11 case report, 459 distal stump, 86–87 C5, C6 and C7, repair of, 461 document used for, 186 cocontraction, 463 infraclavicular part of, 265 C5 rupture, C6, C7, C8 and T1 avulsion, 462 lesions in, pain control, 540–541 findings, 460 lesions, upper limb neuropathies grading of results of, 460 adult traumatic brachial plexopathy, 214 late reinnervation, 462 birth lesion of, 217–218 results of repair, 461 electrodiagnostic findings, in pre and post-ganglionic spinal nerves, 460, 461 lesions, 214 ulnar nerve, 459 elements, 215 Index 633

neuralgic amyotrophy, 216–217 Complex subluxation (CS), 470 injury, 215–216 Compound muscle action potential (CMAP), 193, 194, 210 true neurogenic thoracic outlet syndrome, 216 Compound nerve injury orthosis, 620 amputation revascularisation penetrating missile injuries, 326–327 brachial plexus, 333–334 preganglionic injury of, 533–534 closed infraclavicular lesion, 334–339 Brachio radialis, elbow, 179 contraindications, 303 Brain derived nerve factor (BDNF), 44–45 lower limb Brainstem and cervical cord, laminectomy, 4 femoral nerve, 360–361 British Association of Otorhinolaryngologists (2002), 485 hip, 363–365 British Society for , 206, 207 lumbo sacral plexus, 361–363 Buccal technique, third molar , 509–510 peroneal and tibial nerves, 365–367 Royal National Orthopaedic Hospital, 367–369 C nerves and bone and joint injuries Carcinoma and lympho-proliferative disease, 489 clavicle, 344–345 Carpal tunnel syndrome, 99, 282 elbow, 356–359 Cauda equina, dorsal vessels, 58 forearm, 359–360 Causalgia gleno-humeral , 345–351 case report, 542, 544, 545 iatrogenous injuries, 359 definition of, 542 incidence, 351–355 incidence and, 543–544 musculocutaneous nerve, 355–356 nerve lesion in, 543 nerve to serratus anterior, 344 response to direct treatment, 547–548 pattern of fracture, 341–343 response to sympathetic block/sympathectomy, 546 radial nerve and fractures of humerus, 351 Cell body and proximal stump, reactions to injury spinal accessory nerve, 343–344 chromatolysis, 83 penetrating missile injuries contralateral effects, 85 ballistic peripheral nerve injuries, 331 delay, 84 bilateral lesions, 332 injection injury, 85 brachial plexus, 326–327 , wounds of, 84–85 delayed primary suture, 323 TRPV1, 83 grafts, 324–326 Central motor conduction time (CMCT), 194–196 high energy transfer (HET), tissue damage, 327 Central nervous system incidence, cause and distribution, 330 definition, 1 low energy transfer (LET), tissue damage, 327 pain massive energy transfer (MET), tissue damage, 327 ablation, 557–558 military rifle bullet wound, 323 case report, 556 MRCR evidence, 323–324 stimulation, 556–557 nerve lesion, 330 Cerebral palsy, reconstruction nerves, 331–332 hip, dislocation of, 565 pain, 328, 330–331 severe pain from dysplasia, 565 peripheral nerves, 328–330 Cervical cord, laminectomy, 4 recovery, 331 Cervical nerves, from spinal cord, 1 sacular aneurysm, 330 Cervical plexus, anterior primary rami, 8, 9 shot gun blast, 322 Cervico thoracic (stellate) ganglion, 34 sciatic nerve, suture, 303 Chest and abdomen, sympathetic system, 35 skin, 320–321 Circumflex nerve vascular lesion avulsion lesion, 266 arterio-venous fistula, axilla, 316 reinnervation of, 252 catastrophic bleeding, 307 rupture of, 154 circumferential rupture, 311 Clavicular head, of pectoralis major, 178 elbow, 312 Clinical psychologist, responsibilities, 610 emergency arterial repair, 308 Closed supraclavicular lesion. See Preganglionic injury false aneurysm and arteriovenous fistulae, 313–316 Closed traction lesions, 384–385 femur and tibia, fracture, 314 Cocontraction, 463 iatrogenous false aneurysm, 317 nerve transfer, 132–133 iatrogenous ischaemic injury, 319–320 Cognitive behavioural , 515–516 iatrogenous post ischaemic contracture, 319 Cold thermal nerve injury, 204 ischaemia and nerve, 316–318 Common peroneal nerves, 272–273 knee, 312–313 lower limb neuropathies, 219–220 leaking aneurysm, 310 Complex dislocation (CD), 470 multiple fragment wounds, 307 Complex regional pain syndrome (CRPS) Poiseuille’s law, 312 causalgia, type 2 proximal humerus, fracture, 310 case report, 536 shoulder, 309–312 diagnostic criteria, 535 supraclavicular plexus and penetrating missile wounds, 309 fracture/soft tissue injury, 536–537 tissue-compartment syndrome, 318 634 Index

traumatic false aneurysms and arterio-venous fistulae, 309 Denervation, peripheral effects, 109–110 ulnar artery repair, 307 Dental procedure, trigeminal nerve injuries, 501–502. See also war wounds Trigeminal nerve injury, iatrogenous injuries contamination, 304 Dermatomes distribution, 24 gas gangrene, 305 upper limb, 12 missile wounds, leg, 306 Desensitization, rehabiltation, 612–613 principles, 305 Diabetes, iatrogenous injuries stages, 305–306 hypothyroidism and acromegaly, 488 Compound sensory action potential (SNAP), 192, 193 neuropathy, 487 Computerised tomographic scan, preganglionic injury, 396 Dorsal horn, nocicipient, 531–532 Cone beam CT scanning (CBCT), of third molar, 511 Dorsal primary ramus, 385–386 Connective tissue disease, iatrogenous injuries Dorsal root ganglion (DRG) neurone, 43, 44 carcinoma and lympho-proliferative disease, 489 Dorsal root, regeneration, 136–137 case report, 488–489 Dorsi flexor muscles, paralysis, 600 immune brachial plexus neuropathy, 489–490 Double crush syndrome, 223 rheumatoid neuropathy, 488 Consultant, responsibilities, 610 E Contact heat evoked potential stimulator (CHEPS), 165, 166 Elbow Conventional grafting, limitations, 124–125 anterior primary rami, 15 Conventional nerve transfers, 410 collateral vessels, 38 Conversion paralysis, 626–627 deformities, 478–479 Cord lesion flexion, 179 haematoma and displacement, 380–381 and extension of, 434 level of injury, 380 locking component, orthosis, 616 Coronectomy, third molar surgery, 510–512 reconstruction Cortical maps, 71 extension of, 580 Cranial nerves flexion of, 580–582 brachial plexus ulnar nerve, 208–211, 282, 284 cervical and, 9 ulnar neuropathy, 284, 285 excision of clavicles, 10 Electrical neural injury, 204 and great vessels, 11 Electric shock, 104–106 left, 11 Electrodiagnostic techniques. See Peripheral nerve brainstem and cervical cord, laminectomy, 4 injuries, clinical neurophysiology facial nerve, terminal branches of, 6 Electromyography (EMG), 195, 197 hypoglossal nerve, 7 findings, in peripheral nerve injuries, 205 spinal accessory nerve, 7 Electrophysiological examination, nerve injury, 185–187 spinal cord and brain stem junction, 5 Electrotonus, 194–195 11th cranial nerve, formation of, 5 Endodontic related nerve injury, 507–509 CRPS. See Complex regional pain syndrome algorithm, 509 Crush injuries, 97–98 medicaments, 508 Cutaneous sensation, recovery, 130 radiographs, 508 Cutaneous sensibility, somatic sensory system End-organs, regeneration, 131 glabrous skin and hairy skin, 63 Endoscopy, preganglionic injury, 398 immuno reactivity in, 64 Entrapment neuropathy small diameter nociceptor cell bodies, 64 first rib, 276 small fibre neuropathy, 64 seventh cervical rib, 276–280 Cutaneous sensory receptors, 63 suprapleural membrane (Sibson’s fascia), 276 low threshold mechanosensors, 65 thoracic outlet syndromes, 275–276 nociceptors, 65–66 Entrapment syndromes thermoreceptors, 65 lower limb, 285 upper limb, 284–285 D Entubation, 127 Deafferentation pain, 529–530 Envenomation, 108 Deformities , 52 BLBP Epineurotomy, 243 biceps pseudotumor, 463 Equino-varus deformity, of ankle and foot, 573 C7 and C8, poor recovery for, 467 Extensor carpi radialis, 180 clavicle and scapula shortening, 464 Extensor carpi radialis longus ( ECRL), 592–593 elbow and forearm, 478–479 Extra osseous Ewing’s tumour, from sympathetic chain, 298 flexor origin, proximal advancement of, 467 injuries inflicted during, 463 F limb, denervation of, 464 Facial nerve, terminal branches, 6 persisting muscular imbalance, 464–465 Femoral and sacral plexuses, ganglionated sympathetic chain, 19 shoulder dislocation, closed manipulation of, 466 Femoral nerve, 20, 21 supination, 478–479 lower limb neuropathies, 221 fixed, 569–572 sensibility loss, 158 Demyelination, electrophysiological consequences, 201 and vessels, inguinal ligament, 39 Index 635

Fiolle and delmas, operation, 256, 258 Hip First rib, 276 abduction and flexion of, 596–597 Fixed deformity, 569–572 dislocation, 565 Flexor carpi ulnaris, 587, 588 Histamine induced flare response, 165 Flexor digitorum superficialis (FDS), 180, 588–589 Holt’s method, suprascapular nerve, 411 Foot Horse radish peroxidase (HRP), 136 and ankle, drop foot from common peroneal palsy Hyperpathia, 529 dorsi flexor muscles, paralysis of, 600 Hypoglossal nerve, 7 tibialis posterior (TP) transfer, 598–600 Hypothyroidism and acromegaly, 488 atrophy, 110 equino-varus deformity of, 573 I insensate, 596 Iatrogenous injuries orthosis, 596 case report, 484–485 posture of, CRPS type I, 536 causes small muscles, 182 alcohol, 487 Forearm connective tissue disease, 488–490 deformities, 478–479 continuity of care, timing of operation, 493 superficial radial and lateral cutaneous nerves, 18 diabetes, 487–488 transection of, 156 generalised disorders, 486–487 Free functioning muscle transfer (FFMT), 406 specialisation, 493 Freeze thawed muscle graft (FTMG), 126–127, 252 teaching and training, 492–493 Functional splinting warning and consent, 490–492 reconstruction, 568 incidence and audit, 485–486 rehabiltation, 613 prevention of audit and consent, 499 G conduct of affairs, 499–500 General Dental Council (GDC), 502 recognition and action, 500 Generalised disorders, iatrogenous injuries, 486–487 teaching and training, 499 Generalised polyneuropathy, 224 radiation neuropathy Glabrous skin and hairy skin, somatic sensory system, 63 malignancy, 498 Gleno-humeral arthrodesis, 579, 581 operation, site of, 498–499 Gleno-humeral joint, 578–580 referrals, 483 dislocation total hip arthroplasty, nerve lesions in nerve lesions, 346 findings in, 494–496 pain, 346–351 incidence of, 494 vascular injuries, 345–346 urgent reexploration, indications for, 496–497 posterior subluxation and dislocation (PS/PD) trigeminal nerve injury (see Trigeminal nerve injury, active range of movement, 473 iatrogenous injuries) AP and axial radiographs, after glenoplasty, 476 Immune brachial plexus neuropathy, 489–490 course to recovery, after relocation, 474–475 Implant related nerve injuries, 504–507 diagnosis and classification, 469–470 aetiology of, 506 incidence of, 472 algorithm, recommended management of, 507 inferior scapulo-humeral angle, fixed contracture of, 478 bilateral IAN injury, 505 lateral rotation osteotomy, shoulder dislocation, 471 intra-operative, 505 medial rotation contracture, 470–471 post operative, 505 radiological and operative findings in, 476 prevention of, 506–507 reduction, anterior approach, 472 Impulse generation, 531 secondary deformities, onset and progression of, 467–469 Infant, cutaneous sensation recovery, 130 shoulder function, 477 Inferior alveolar nerve injury (IANI), 502, 518–520 subluxation, 616 Inferior scapula-humeral angle (ISHA), 170 Glial cells, 43 Infraspinatus, 177 Glial derived nerve factor (GDNF), 45, 46 Injection injury, 85, 106–107 Gluteus maximus, splitting, 272 Injury. See Reactions to injury Golgi tendon organs, 68–69 Insensate foot, 596 Grafts Insulin growth factor (Igf), 45 case report, 249 Intercostal nerves elevation and preparation of, 247 spinal accessory nerve, 250, 251 regeneration, 123–125 transfer, 410 vascularised, 248–249 ulnar to biceps transfer, 250–251 C6 and C7 avulsed ventral roots, reinnervation of, 252 H C5 and of C6 avulsion, dorsal scapular palsy, 251 Hand circumflex nerve, reinnervation of, 252 lesions, of ulnar nerve, 181 Interosseous muscles, contracture, 576 median and ulnar nerves in, 17 Intradural injury, regeneration nerve lesions and, 593–595 dorsal root, 136–137 Hemilaminectomy, 3 horse radish peroxidase (HRP), 136 High resolution ultrasonography, nerve injury, 188 ventral root, 136 636 Index

Ion channels, peripheral nerve fibres sciatic nerve, 219 mucosa and submucous plexus, in human rectum, 57 tibial nerve and branches, 220–221 sodium channel staining, sural nerve, 56 Lumbar and sacral anterior primary rami, of spinal nerves Ischaemia ankle and heel, 30 acute, 87–88 dermatomes, distribution of, 24 and acute compression, neurovascular fascial compartments, femoral and sacral plexuses, ganglionated sympathetic chain, 19 90, 92, 93 femoral nerve, 20, 21 chronic, 97 left foot, sole of, 31 and conduction, 232 limb, posterior aspect of, 26 neurostenalgia, 550 lower limb, anterior aspect of, 25 swollen muscle, 92–95 peroneal nerve, 29 Marfan’s syndrome, 95 popliteal fossa, 27, 28 spinal accessory nerve, 95 sacral plexus, 21–22 staphylococcal septicaemia, 95 sciatic nerve and components, 23, 24 from tamponade Lumbosacral plexopathy, 222 case report, 90 Lympho-proliferative disease, 489 interscalene block, permanent defects in, 91 traction, 95–96 M Magnetic resonance imaging K nerve injury, 187–188 Knee, 597–598 preganglionic injury, 396–397 collateral circulation, 40 Malignancy, radiotherapy, 498 extension of, 182 Malignant peripheral nerve sheath tumours (MPNST), 108 hamstring to quadriceps transfers in, 597 clinical features, 294 histopathological findings in, 295 L operation, principles of Laminectomy, brainstem and cervical cord, 4 extra osseous Ewing’s tumour, from sympathetic chain, 298 Late onset cord lesion, mechanical causes, 382 massive neuroblastoma, 298 Latissimus dorsi transfer, 578–580, 583–584 neuroepithelioma, 297 Limb NF1, 296 BLBP open biopsy, in thigh, 295 denervation of, 464 primitive neurectodermal tumours, 296 growth, 434–435 , 294 lengthening and traction, 497 Mallet chart, BLBP, 435 lower (see Lower limb) Marfan’s syndrome, 95 upper (see Upper limb) Massive neuroblastoma, 298 Linear abrasions, 377 Mechanosensors, low threshold, 65 Lingual nerve injury (LNI), 502, 509, 516 Medial rotation contracture (MRC), 470 Local analgesia (LA), trigeminal nerve injury, 503–504 Median nerves, 266–269 prevention of, 504 anterior primary rami, 16 Lower limb, 174–175, 177, 594–595 in arm and axilla, 266 ankle, eversion, 182 of distal stump, 86 compound nerve injury injury, 156 femoral nerve, 360–361 primary suture, wrist, 246 hip, 363–365 proximal stump of, 118 lumbo sacral plexus, 361–363 sensibility loss, 157 peroneal and tibial nerves, 365–367 thermal damage, 104 Royal National Orthopaedic Hospital, 367–369 upper limb neuropathies conventional ankle/foot orthosis, 596 anterior interosseous nerve syndrome, 208 entrapment syndromes, 285 case report, 208 foot and ankle, drop foot from common peroneal palsy, forearm, post-operative appearance of, 208 598–600 high, 207–208 foot, small muscles of, 182 wrist, 206–207 hip, abduction and flexion of, 596–597 Meralgia paraesthetica, 221, 285 insensate foot, 596 Metacarpophalangeal joints, 574–575 knee, 597–598 Microscopic structure, of nervous system extension of, 182 axoplasm, 43 hamstring to quadriceps transfers in, 597 cortical maps, 71 neuropathies cultured human dorsal root ganglion neurone, 43 common peroneal nerve, 219–220 DRG neurone femoral nerve, 221 cultured and immunostained, 44 lumbosacral plexopathy, 222 phase contrast image of, 43 meralgia paraesthetica, 221 glial cells of, 43 obstetric nerve injuries, 221–222 nerve growth factor root lesions, electrodiagnosis in, 223 BDNF, 44–45 saphenous nerve lesions, 222 GDNF, 45, 46 Index 637

glabrous arm skin, basal epithelial cells in, 46 direct substitution, 167 immuno reactivity in, 44 motor recovery, 167 insulin growth factor (Igf), 45 muscle power, measurement of, 167–168 neurotrophin 3 (NT3) immunostaining, 46 rebound, 167 subepithelial fascicles of, 46 tenodesis action, 167 theory, 44 trick movements, 166–167 peripheral nerve fibres (see Peripheral nerve fibres) reinnervation, signs of, 180–182 somatic motor system, 61–62 Muscular neurotisation, 252 somatic sensory system Musculocutaneous nerves central connections, 69–70 anterior primary rami, 14 cutaneous sensibility, 62, 64 rupture, 154 cutaneous sensory receptors, 65–66 sensory loss, 155 deep sensibility, 66, 67 Musculo skeletal injury, nerves risk golgi tendon organs, 68–69 elbow, collateral vessels, 38 skin, 64–65 fascia, 37 visceral afferents, 70–71 femoral nerve and vessels, inguinal ligament, 39 synaptic activity, 72 knee, collateral circulation, 40 Morton’s metatarsalgia, 220, 287 popliteal and anterior tibial arteries, 40 Motor evoked potentials (MEPs), 199 Myelinated nerve fibre, 50 Motor neurone cell bodies, in ventral horn, 62 Myelography, preganglionic injury, 394, 396 MPNST. See Malignant peripheral nerve sheath tumours Munchausen syndrome, 627–628 N Muscle National Health Service (NHS), 485 myopathic disorders, 224 Neck, 254 spindles, 66, 68 close range shot gun blast, 146 somatic sensory system, 24, 26 course in, 378–379 transfer, reconstruction, 601 superficial nerves in, 238 Muscle examination, nerve injury Nerve action potential (NAP), 192–193, 198 clinical, 168–171, 173–174 Nerve fibres abduction, initiation of, 177 neuronal cell bodies and, 136 adductors and medial rotators, 173 reorganisation, 118–119 brachio radialis, elbow, 179 Nerve growth factor (NGF) clavicular head, pectoralis major, 178 BDNF, 44–45 deltoid, 174 GDNF, 45, 46 elbow flexion, 179 glabrous arm skin, basal epithelial cells in, 46 extensor carpi radialis, activity in, 180 immunoreactive fibres in, 122 fingers, long flexors of, 174 immuno reactivity in, 44 flexor digitorum superficialis, 180 insulin growth factor (Igf), 45 hand lesions, of ulnar nerve, 181 neurotrophin 3 (NT3) immunostaining, 46 inferior scapula-humeral angle (ISHA) in, 170 in pain, 533 infraspinatus, 177 subepithelial fascicles of, 46 intrinsic muscles, 174 Nerve injury, clinical aspects rotator cuff, rupture of, 178 avulsion of scapula movement, circumflex nerve rupture, 176 C5, 151 scapular winging, serratus anterior lesion, 173 C4, C5, C6, C7, 151 serratus anterior, 170–171, 173 C4-T1, 150 spinal accessory and serratus anterior, 171 C5-T1, sensory loss in, 150 spinal accessory palsy, 172 axilla, medial cord rupture, 153 sternal head, pectoralis major, 178 C5 and C6, rupture of, 152 suprascapular and circumflex nerves, 176 C8 and T1, transection of, 152 trapezius, 171 circumflex nerve, rupture of, 154 upper limb, elevation of, 175 diagnosis late signs of, 177, 179–180 electrophysiological examination, 185–187 post ischaemic contracture, in hand, 183 high resolution ultrasonography, 188 post ischaemic fibrosis, 184 magnetic resonance imaging, 187–188 skin changes, 184 examination, 148 lower limb, 174–175, 177 forearm, transection of, 156 ankle, eversion, 182 history, 145 foot, small muscles of, 182 infant’s hand, palmar nerves, 159 knee, extension of, 182 level and depth of, 151–154 methods massive blast injury, 149 grip and pinch, measurement of, 169 median nerve injury, 156 shoulder, measuring power of, 170 military rifle bullet, debridement, 148 pitfalls muscles, examination of (see also Muscle examination, accessory insertion, 167 nerve injury) anatomical variations, 167 clinical, 168–171, 173–174 638 Index

late signs of, 177, 179–180 dislocation, 356 lower limb, 174–175, 177 prevention, 358–359 methods, 168 Volkmann’s contracture and supracondylar fracture, 357–358 pitfalls, 166–168 forearm, 359–360 reinnervation, signs of, 180–182 gleno-humeral joint dislocation musculocutaneous nerves, rupture of, 154 nerve lesions, 346 neck, close range shot gun blast, 146 pain, 346–351 pain, 148 vascular injuries, 345–346 penetrating missile wound, 146, 147 iatrogenous injuries, 359 Platt lesion, 146 incidence quantitative sensory testing (QST) compound lesions, radial nerve, 353 conduction, in somatic efferent pathways, 166 decompression/extrication (neurolysis), 354 contact heat evoked potential studies, 166 iatrogenous lesions, 354–355 histamine induced flair assessment, laser, 165 lesions recovery, 352 magnetic stimulation of, 167 open fracture, 352 monofilament perception, punctate touch, 164 Tinel sign, 353–354 sweat testing, 165 musculocutaneous nerve, 355–356 vibration perception thresholds, measurement of, 165 pattern of fracture, 341–343 warm and cool thermal thresholds, testing of, 164 radial nerve and fractures of humerus, 351 radial nerve, lesion of, 155 serratus anterior, nerve to, 344 records, 182, 184–185 spinal accessory nerve, 343–344 brachial plexus, document used for, 186 Nerve transfer compound nerve injury, document used for, 185 conventional, 410 red cross wound classification, 147 elbow flexion, 411 sacral plexus, cutaneous distribution of, 158 repair technique, 398–399 sciatic nerve, bullet wound, 146 Nervi nervorum, 59 sensibility, examination of, 161–163 Nervous system, definition, 1 chart recording improvement, measurement, 163 Neuralgic amyotrophy, 216–217, 489–490 sensory recovery, 162 Neural outlet syndrome, without plain motor signs, 279–280 sensibility loss , 79, 203–204 femoral nerve, 158 Neuroepithelioma, 297 median nerve, 157 Neurogenic thoracic outlet syndrome, 279 sensory abnormality, lateral cord in axilla, 152 Neurolysis, 241–243 sensory loss epineurotomy, 243 and clawing, ulnar nerve, 157 external, 242 musculocutaneous nerve rupture, 155 futile, 243 peroneal nerve, 159 Neuroma, 121–122, 518 sciatic nerve transection, in thigh, 158 containment of, 555 signs of, 154–156 prevention of, 555 sympathetic paralysis, transection of, 149 Neuronal cell bodies and nerve fibres, 136 symptoms and signs, 148, 150–151 Neuropathic pain, 528, 538, 625–626 Tinel’s sign, 156, 157, 159 Neurophysiological examination, 234–235 brachial plexus, traction lesions of, 161 Neurophysiological investigations (NPI), BLBP in closed lesions, 159–161 outcome, electrodiagnostic grade, 449 degenerative lesions, prognosis in, 160 pre-operative NPI investigations, 450–452 and recovery, 161 Neuroplasticity, 517 static and progressing, 160 Neurostenalgia, pain wounds case report, 549, 550 categories of, 148 duration of symptoms, 550–551 system scores, features, 147 ischaemia, 550 wrist, median and palmar cutaneous nerve, 156 Neurotmesis Nerve repair, operation and , 81–82 epineurium and perineurium, 249 peripheral nerve injuries, 204 free vascularised ulnar nerve graft, 249 Neurotrophin 3 (NT3) immunostaining, 46 grafting, 247–249 Neurotrophins, 44–46 immobilisation, 252–254 Neurotropism, 115 nerve transfers, 249–252 Nociceptors, 65–66 primary suture of, 246, 247 Nocicipient. See Pain principles, 245 Nodes of Ranvier, 50, 52 stumps in traction injury, of radial nerve, 245 Nursing staff, responsibilities, 610 suture, methods of, 245–247 tidy wound, 244 O wrist, median nerve, 246 Obstetric nerve injuries, 221–222 Nerves and bone and joint injuries Occupational therapist, responsibilities, 610 clavicle, 344–345 Omotrain orthosis, 619 elbow Operations Index 639

anterior route, 280 seventh cervical and first thoracic ribs, removal of, 281 apparatus and instruments tarsal tunnel syndrome, 286–287 hand, radial side of, 238 technique of, open method, 282–284 magnification, 235 transaxillary approach, 281–282 neck, superficial nerves in, 238 tumours of, pitfalls in neurophysiological examination, 234–235 intraneural ganglion, 289–290 normal and abnormal SSEP traces, 237 MPNST, 293–298 pain, prevention of, 236–237 solitary benign schwannoma, 287–292 records, 240, 241 solitary neurofibroma, 290–293 severe pain and deep paralysis, gleno-humeral joint, 236 ulnar neuropathy, elbow approaches anterior transposition, complications of, 285 neck, 254 decompression, 284 postero-lateral route, 259–262 transposition, 284 transclavicular exposure, 256–260 Orthosis, 613, 616 transverse supraclavicular approach, 254–258 ankle/foot, 596 avulsion lesion, spinal nerves repair (see Avulsion lesion, spinal Orthotists, responsibilities, 610–611 nerves repair) birth lesions of brachial plexus (BLBP) P incomplete lesion, 454 Pain, 527, 528 indications for, 453–454 causalgia, 542–549 intra operative conduction studies, 455 central nervous system, interventions paralysis, evolution of, 454 ablation, 557–558 post-operative care, 456–457 case report, 556 repair, methods of, 456 stimulation, 556–557 ruptured C5 repair, with avulsion, 457 complex regional pain syndrome (CRPS) bleeding, control of, 233–234 causalgia, type 2, 535–536 carpal tunnel syndrome, 282 fracture/soft tissue injury, 536–537 complications and, 282 and deep paralysis, gleno-humeral joint, 236 dangers of, 281 nerve injury, 148 entrapment neuropathy neurostenalgia, 549–551 first rib, 276 nocicipient seventh cervical rib, 276–280 allodynia, 529 suprapleural membrane (Sibson’s fascia), 276 brachial plexus, preganglionic injury of, 533–534 thoracic outlet syndromes, 275–276 deafferentation, 529–530 entrapment syndromes definitions of, 529 lower limb, 285 dorsal horn, changes in, 531–532 upper limb, 284–285 ephapses, 531 indications and intervention events, 530–533 diagnosis, 232 gate theory, 530 ischaemia and conduction, 232 hyperpathia, 529 persisting painful median palsy, 233 nerve growth factor (NGF), role of, 533 units, role of, 232–233 post traumatic , central sensitisation in, 532 meralgia paraesthetica, 285 proximal axon and dorsal root ganglion, 531 Morton’s metatarsalgia, 287 spontaneous impulse generation, 531 nerve repair sympathetic nervous system, 534 epineurium and perineurium, 249 operation free vascularised ulnar nerve graft, 249 drugs and measures of, 538–542 grafting, 247–249 indications for, 542 immobilisation, 252–254 during operation, prevention of, 236–237 nerve transfers, 249–252 post traumatic neuralgia primary suture of, 246, 247 amputation neuroma, 553 principles, 245 case report, 552–553 stumps in traction injury, of radial nerve, 245 minor nerves, 554–555 suture, methods of, 245–247 regeneration, 553 tidy wound, 244 spinal accessory nerve and serratus anterior, 553–554 wrist, median nerve, 246 regeneration and, 133–135 piriformis syndrome, 286 relief, preganglionic injury posterior approach, 282 improvement in, 419–420 for post ischaemic contracture, 571 initial and final pain values, 420 pudendal nerve, entrapment of, 285–286 left sided lesion, 417–418 for reconstruction, 564 peripheral nerve injury unit scale, 416–418 repair, methods of response, 420–421 axillary artery, rupture of, 242 Paralysis, 626–627 biopsy, 243–244 Parasympathetic nervous system, 36 neurolysis, 241–243 Pelvis, 270–271 vascular repair, 239, 241, 242 chondrosarcoma, 285 640 Index

Penetrating missile injuries, compound nerves electrodiagnostic techniques ballistic peripheral nerve injuries, 331 case report, 192 bilateral lesions, 332 central motor conduction time (CMCT), 194–196 brachial plexus, 326–327 compound muscle action potential (CMAP), 193, 194 delayed primary suture, 323 compound sensory action potential (SNAP), 192, 193 grafts, 324–326 electromyography (EMG), 195, 197, 198 high energy transfer (HET), tissue damage, 327 electrotonus, 194–195 incidence, cause and distribution, 330 F response, 194 low energy transfer (LET), tissue damage, 327 H reflex, 193–194 massive energy transfer (MET), tissue damage, 327 limitations and pitfalls of, 199–201 military rifle bullet wound, 323 and localisation, 199 MRCR evidence, 323–324 mixed nerve action potential (NAP), 192–193 nerve lesion, 330 neuromuscular transmission, tests of, 194, 196 nerves, 331–332 quantitative EMG (QEMG), 197 pain, 328, 330–331 quantitative sensory testing, 195, 197 peripheral nerves, 328–330 sensory evoked potentials (SSEPs), 195, 197 recovery, 331 surface EMG, 197 sacular aneurysm, 330 intra-operative neurophysiological procedures shot gun blast, 322 free running and stimulated EMG, 198 Penetrating missile wound, 146, 147 motor evoked potentials (MEPs), 199 Percussion injury, 106 nerve action potentials, 198 Perineurium, 52 somatosensory, dermatomal and root evoked potentials, intraneurial ganglion, 100 198–199 and neoplasm/infiltration, 107–108 lower limb neuropathies, clinical applications wounds of, 84–85 common peroneal nerve, 219–220 Peripheral nerve fibres disorders, 221–222 afferent and efferent fibres femoral nerve, 221 paths of, 48 lumbosacral plexopathy, 222 ventral root, 49 root lesions, electrodiagnosis in, 223 ageing, changes in nerves with, 59–61 sciatic nerve, 219 avulsed dorsal root, transverse section of, 47 tibial nerve and branches, 220–221 avulsed ventral root, intradural rupture, 47 pathophysiological response of axonal transport, 57 axonotmesis, 204 blood supply of classification and, 203 neck, resin cast of, 59 cold thermal nerve injury, 204 segmental medullary (radicular) arteries and anterior spinal demyelination, electrophysiological consequences of, 201 artery, 60 electrical neural injury, 204 spinal cord and cauda equina, dorsal vessels, 58 electromyography (EMG) findings in, 205 conduction, 54, 56 neurapraxia, 203–204 DRG neurones and Schwann cells, in vitro cultures of, 50 neurotmesis, 204 epineurium, 52 radiation injury, 204–205 fascicular arrangement of, 55 regeneration and reinnervation, 205–206 ion channels temporal sequence of, 202 mucosa and submucous plexus, in human rectum, 57 types of, electrophysiological consequences, 202–205 sodium channel staining, sural nerve, 56 safety, 201 myelinated nerve fibre, 50 upper limb neuropathies, clinical applications nervi nervorum, 59 axillary (circumflex) nerve, 213 nodes of Ranvier, 50, 52 brachial plexus lesions, 214–219 perineurium, 52 long thoracic nerve, 213–214 Schmidt–Lanterman incisure, 51 median nerve, 206–208 Schwann cell development, 49 radial nerve, 211–212 spinal cord, morphology of, 47 spinal accessory nerve, 213 sural nerve suprascapular nerve, 212 double immunostaining of, 52 ulnar nerve, 208–211 , 54 Peroneal nerve, 29 transitional region/zone (TZ), 46, 47 sensory loss, 159 ulnar nerve Phantom limb, reactions to injury, 110–111 bundles and epineurial vessels of, 53 Phrenic nerve, 9 extrinsic epineurial vessels of, 53 Physiotherapists, responsibilities, 610 unmyelinated , clusters of, 51 Physiotherapy and BLPP, 611–612 ventral root, rupture of, 50 Piriformis syndrome, 219, 286 Peripheral nerve injuries, clinical neurophysiology Plantar nerves and tibial nerve, 273, 275 diffuse problems Platt lesion, 146 anterior horn cell disorders, 224 Poliomyelitis, 584 case report, 224–225 Popliteal and anterior tibial arteries, 40 generalised polyneuropathy, 224 Popliteal fossa, 27, 28 muscle/myopathic disorders, 224 tibial and common peroneal nerves, 272–274 Index 641

Positron emission tomographic scan, 110 C5, C6 and C7, 402 Posterior interosseous nerve, 267, 269 C5, C6, C7, C8, intact T1, 402–403 Posterior interosseus neuropathy, 212 complete lesion, 404–406 Posterior primary rami, of spinal nerves, 32 free functioning muscle transfer (FFMT), 406 Postganglionic lesion graft, 400 dorsal primary ramus, 385–386 injury patterns, 400 somatosensory evoked potentials (SSEP), 386–388 left sided lesion., 406 Post ischaemic cord lesion, late onset, 381 lower lesion, 404 Post ischaemic fibrosis, 570–571 middle group, 404 Post operative infection related nerve injuries, 513 quantitative sensory testing, 406, 407 Post traumatic neuralgia (PTN), 551 right sided lesion, 407 amputation neuroma, 553 ventral root (VR) repair, 403 case report, 552–553 repair technique central sensitisation in, 532 direct repair, ruptured ventral roots, 399 extreme central sensitisation in, 535 nerve transfer, 398–399 iatrogenous division of, 554 reinnervation, avulsed ventral root, 399 minor nerves vascularised ulnar nerve graft (VUNG), 399 case report, 554–555 results containment of neuroma, 555 avulsed ventral roots repair, 410–411 prevention of neuroma, 555 conventional nerve transfers, 410 repair, 555 definitions, 409–410 translocation, 555 methods, 409 regeneration, 553 spinal cord lesions spinal accessory nerve and serratus anterior, 553–554 cord lesion, 380 Preganglionic injury late onset cord lesion, 382–383 anatomy post ischaemic cord lesion, 381–382 functional distribution, 379–380 unrelated cord injury, 380 micro anatomy, 379 total avulsion, 377 neck, course in, 378–379 types, 375 classification, 376 Primitive neurectodermal tumours (PNET), 296 closed traction lesions, 384–385 Progressive neurological disease, 624 diagnosis PTN. See Post traumatic neuralgia computerised tomographic scan, 396 Pudendal nerve, entrapment, 285–286 endoscopy, 398 examination, 390 Q injury, cause, 389 Quantitative EMG (QEMG), 197 inspection, 390 magnetic resonance imaging, 396–397 R myelography, 394–396 Radial nerve, 14, 98, 266–267 operation, 398 lesion, 155 pain, 389–390 upper limb neuropathies, 211–212 plain radiographs, 392–394 Radiation rupture, 392 injury, 204–205 Tinel’s sign, 390–391 neuropathy, 109 ultrasonography, 398 neuropathy, iatrogenous injuries, 497 epidemiology, 388–389 malignancy, 498 function, patient recovery operation, site of, 498–499 age, 415–416 and peripheral nerves, 108, 109 results of, 412–415 thrombosis, subclavian artery, 109 vascularised ulnar nerve graft, 411–412 Reactions to injury injury mechanisms, 376–378 axonotmesis and neurotmesis linear abrasions, 377 focal mechanical nerve injury, pain relief classification of, 82 improvement in, 419–420 hour glass constriction of, 82 initial and final pain values, 420 case report, 78 left sided lesion, 417–418 cell body and proximal stump peripheral nerve injury unit scale, 416–418 chromatolysis, 83 response, 420–421 contralateral effects, 85 pre and postganglionic lesion delay, 84 dorsal primary ramus, 385–386 injection injury, 85 somatosensory evoked potentials (SSEP), 386–388 perineurium, wounds of, 84–85 reimplantation, avulsed spinal nerves TRPV1, 83 Bonney, George, 421–423 conduction block, 78, 79 Carlstedt, Thomas, 423–425 deepening of lesion, 77 repair strategies degenerative lesion, 79 bilateral lesion, 407–409 denervation, peripheral effects of, 109–110 C5 and C6, 400–402 distal stump 642 Index

brachial plexus, 86–87 osteotomy, 572–573 dorsal root ganglion, 88 pectoralis minor transfer, 582–583 of median nerve, 86 step elongation, 572 nerve and roots detached from, 88 tenotomy, 572 rupture and avulsion of, 89 paralysis of sepsis, rupture, 87 brachial artery and musculocutaneous nerve repair, 587 ulnar nerve, 80 flexor carpi ulnaris, 587, 588 Wallerian degeneration in ventral root of, 89 flexor digitorum superficialis, transfer of, 588–589 envenomation, 108 pre and post-operative care, 586–587 ischaemia radial nerve palsy, splint for, 586 acute, 87–88 radial palsy, 588 and acute compression, neurovascular fascial wrist extension, 585 compartments, 90, 92 requirements chronic, 97 fixed deformity, 569–570 swollen muscle, 92–95 flexor carpi ulnaris, 567 from tamponade, 89–90 flexor, post operative splint for, 567 traction, 95–96 humerus, infected non-union of, 567 nerves persisting imbalance during growth, 569–570 damage to, 77 post ischaemic fibrosis, 570–571 pressure effect on, 78 pre-requisites for, 565 neurapraxia, 79, 80 serial splinting, 571–572 non-degenerative lesion, 79 simple functional splinting, 568 perineurium and neoplasm/infiltration, 107–108 tension of transfer, 568–569 phantom limb, 110–111 shoulder girdle physical agents, lesion types gleno-humeral joint, 578–580 acute compression, 98–99 thoraco-scapular joint, 576–578 chronic nerve compression, 99–100 vascularized bone and muscle transfer, 601 crush, 97–98 Reflex sympathetic dystrophy, 536–537 electric shock, 104–106 Regeneration and recovery injection injury, 106–107 delay, 140 percussion injury, 106 factors in prognosis reperfusion injury, 96 age, 139 thermal injury, 103–104 level of injury, 139–140 traction/stretch injury, 100–103 sensation, 139 vibration injury, 107 function after nerve repair radiation and peripheral nerves, 108, 109 case report, 138 Wallerian degeneration, distal stump of cervical nerve, 81 grading of results, 138–139 Reconstruction quality of, 137–138 amputation, 601–602 recall, 138 cerebral palsy intradural injury hip, dislocation of, 565 dorsal root, 136–137 severe pain from dysplasia, 565 horse radish peroxidase (HRP), 136 elbow ventral root, 136 extension of, 580 large gaps, repair of flexion of, 580–582 allografts, 125–126 group IV BLBP, 566 conventional grafting, limitations of, 124–125 high median palsy entubation, 127 brachioradialis (BR) to flexor pollicis longus (FPL), 591 failure of, vascularised sural nerve graft, 126 extensor to flexor transfer in C8/T1, 591 freeze thawed muscle graft (FTMG), 126–127 opposition transfer, 590 grafts, 123–125 tenodesis effect of, wrist extensor muscles, 590 methods of, 123 thumb, abduction and opposition of, 589–591 proximal suture line, 126 high ulnar palsy vascularised ulnar nerve graft, 125 ECRL for, 592–593 nerve and axon response, to transection extensor digiti minimi transfer, 592 case report, 122–123 iatrogenous lesion, 593 cellular response, 116 nerve lesions and hand, 593–595 compartmentation/mini fascicle formation, 119 operations for, 564 distal stump, 117 ankle and foot, equino-varus deformity of, 573 failure of, 120 arthrodesis, 573 graft, middle of, 120 flexor muscle slide, 573–574 guidance and selection, 119–120 flexor origin, proximal advancement of, 583, 584 maturation, 121 hand, contracted small muscle release of, 575–576 median nerve, proximal stump of, 118 latissimus dorsi transfer, 583–584 nerve fibres, reorganisation of, 118–119 metacarpo-phalangeal joints, fixed extension, 574–575 neuroma, 121–122 muscle slide, 572 neurotrophic factor, 120 Index 643

NGF immunoreactive fibres in, 122 S proximal stump, 117 Sacral anterior primary rami, of spinal nerves. See Lumbar and sacral rate of, 122 anterior primary rami, of spinal nerves ulnar nerve, proximal stump, 119 Sacral plexus, 21–22, 270–271 useless regeneration, 122, 123 cutaneous distribution, 158 Wallerian degeneration, in ulnar nerve, 117 Saphenous nerve lesions, 222 nerve transfer Schmidt–Lanterman incisure, peripheral nerve fibres, 51 case report, 129–130 Schwann cells, 43, 46, 49–51 cocontraction, 132–133 Schwannoma, ankle, 539 contra-lateral transfer, 129 Sciatic nerve, 23, 24, 271–272 cutaneous sensation, 130 bullet wound, 146 deep afferent pathways, 130–132 lower limb neuropathies, 219 end-to-side repair, 128–129 suture, 303 limitations of, 130 transection, in thigh, 158 neuronal cell bodies and nerve fibres, 136 Sensory action potential (SNAP), 192, 193 and pain, 133–135 Sensory evoked potentials (SSEPs), 195, 197, 237 skin staining, nerve markers, 135 Shoulder neurotropism, 115 dislocation, 466, 471 severity of injury, 140 function, 436, 477 Regeneration and reinnervation, peripheral nerve injuries, Shoulder girdle, reconstruction 205–206 gleno-humeral joint Rehabiltation arthrodesis, 579–581 amputation, limbs, 629 latissimus dorsi and teres major, transfer of, 578–580 anterior spinal cord infarction, 622 thoraco-scapular joint choice of intervention, 624–625 levator scapulae and rhomboids transfer, clinical psychologist, 610 trapezius paralysis, 576–577 communication, 608 pectoralis major transfer, serratus anterior paralysis, consultant, 610 577–578 conversion paralysis, 626–627 thoraco-scapular arthrodesis, 578 desensitization, 612–613 Sibson’s fascia. See Suprapleural membrane elbow locking component, 616 Simple posterior dislocation (SD), 470 flail arm splint, 616 Simple posterior subluxation (SS), 470 functional splinting, 613 Skeletal muscle, afferent and efferent innervation, 67 glenohumeral joint subluxation, 616 Skin history, 609–610 somatic sensory system, 64–65 inpatient unit, 616 staining, nerve markers, 135 legislation, 607 Sodium channel staining, sural nerve, 56 malingering, 628 Solitary benign schwannoma modified light weight elbow splints, 620 dumb-bell tumour, cervical region, 291 motivation, 616–624 histopathological features in, 289 Munchausen syndrome, 627–628 massive, in mediastinum, 292 neuropathic pain, 625–626 symptoms and signs in, 288 nursing staff, 610 treatment, 288–289 objectives, 608 upper trunk of brachial plexus, 290 occupational therapists, 610 Solitary neurofibroma, 290–293 Omotrain orthosis, 619 Somatic motor system orthoses, 613, 616 descending tracts in, 61 orthotists, 610–611 motor neurone cell bodies in, 62 pain and hypersensitivity, elbow, 613 Somatic sensory system physiotherapists, 610 central connections, 69–70 physiotherapy and BLPP, 611–612 cutaneous sensibility progressive neurological disease, 624 glabrous skin and hairy skin, 63 proximal humeral shaft fracture, 613 immuno reactivity in, 64 restrictions, 607 small diameter nociceptor cell bodies, 64 shoulder subluxation, 619 small fibre neuropathy, 64 stretching exercises, 612 cutaneous sensory receptors war wounds low threshold mechanosensors, 65 outcomes, 629 nociceptors, 65–66 treatment, 628–629 thermoreceptors, 65 workshop training, 611, 612 deep sensibility, 66, 67 Reimplantation, avulsed spinal nerves, 421–425 golgi tendon organs, 68–69 Bonney, George, 421–423 muscle spindles, 66, 68 Carlstedt, Thomas, 423–425 skin, 64–65 Reperfusion injury, 96 visceral afferents, 70–71 Reversed vein grafting, in axilla, 242 Somatosensory evoked potentials (SSEP), 386–388 Ruptured ventral roots, direct repair, 399 Spinal accessory nerve, 7, 95 644 Index

avulsion lesion, 264–265 Thermoreceptors, 65 upper limb neuropathies, 213 Third molar surgery (TMS), 502 Spinal cord buccal technique, 509–510 descending tracts in, 61 CBCT of, 511 dorsal vessels to, 58 coronectomy, 510–512 lesions, 380–383 DPT radiographs, 510 Spinal nerves juxta apical area, 510 anterior primary rami of lingual nerve injury, 509 brachial plexus, 7, 10, 11 Thoracic anterior primary rami, of spinal nerves, 18 cervical plexus, 8, 9 Thoracic nerve, upper limb neuropathies, 213–214 circumflex (axillary) and suprascapular nerves, 13 Thoracic outlet syndrome (TOS), 216, 275–276 circumflex (axillary) nerve, 13 arterial, 277–279 dermatomes distribution, upper limb, 12 neurogenic, 279 elbow, 15 Thoraco-scapular arthrodesis, 578 forearm, superficial radial and lateral cutaneous nerves of, 18 Thoraco-scapular joint, 576–578 hand, median and ulnar nerves in, 17 Thumb, abduction and opposition, 589–591 median nerve, 16 Tibialis posterior (TP) transfer, 598–600 musculocutaneous nerve, 14 Tibial nerve phrenic nerve, course of, 9 and common peroneal nerves, 272–273 radial nerve, 14 lower limb neuropathies, 220–221 right axilla and arm, nerves in, 12 motor study, 194 suprascapular and circumflex nerves, 13 Tinel’s sign trunks and cords, 7 compound nerve injury, 353–354 ulnar nerve, 16 nerve injury, 156, 157, 159 in BLBP, 460, 461 brachial plexus, traction lesions of, 161 central affect, 431–432 in closed lesions, 159–161 types of, 430, 431 degenerative lesions, prognosis in, 160 lumbar and sacral anterior primary rami and recovery, 161 ankle and heel, 30 static and progressing, 160 dermatomes, distribution of, 24 preganglionic injury, 390–391 femoral and sacral plexuses, ganglionated sympathetic chain, 19 Tissue-compartment syndrome, 318 femoral nerve, 20, 21 TMS. See Third molar surgery left foot, sole of, 31 TOS. See Thoracic outlet syndrome limb, posterior aspect of, 26 Total avulsion, 377 lower limb, anterior aspect of, 25 Total hip arthroplasty, nerve lesions peroneal nerve, 29 findings in, 494–496 popliteal fossa, 27, 28 incidence of, 494 sacral plexus, 21–22 limb lengthening and traction, 497 sciatic nerve and components, 23, 24 nerves, abnormalities of, 495–496 posterior primary rami, 32 outcome, 496 thoracic anterior primary rami, 18 pain, 495, 496 Staphylococcal septicaemia, 95 urgent reexploration, indications for, 496–497 Superficial radial nerve, 212 Traction/stretch injury, 100–103 Supination deformity, 478–479 Transclavicular exposure, 256–260 Suprapleural membrane, 276 Transcranial electromagnetic evoked potentials (TCEMEP), 235 Suprascapular nerve Transcutaneous nerve stimulation avulsion lesion, 265 brachial plexus lesions, pain control, 540–541 transfer, 411 catheter insertion, for supraclavicular brachial plexus block, 540 upper limb neuropathies, 212 continuous peripheral nerve blocks, 540 Sural nerve response to drugs and methods of treatment, 542 double immunostaining of, 52 Transverse supraclavicular approach, 254–258 sodium channel staining, 56 Trapezius, 171 Wallerian degeneration, 54 muscle wasting, in spinal accessory neuropathy, 213 Sural neuropathy, 221 paralysis, muscle transfer, 576, 577 Sweat testing, nerve injury, 165 Trigeminal nerve injury, iatrogenous injuries Sympathetic nervous system dental procedure, features of, 501–502 abdomen and pelvis, 36 General Dental Council (GDC), 502 cervico thoracic (stellate) ganglion, 34 management of, 502 in chest and abdomen, 35 endodontic (ENOO), 507–509 and pain, 534 evaluation of, 513–514 Sympathetic paralysis, transection, 149 implant related nerve injuries, 504–507 Synaptic activity, 72 improved consent, 521 inferior alveolar nerve injury (IANI), 502 T interventions Tamponade, ischaemia, 89–90 medical, 516 Tarsal tunnel syndrome, 220, 286–287 surgical, 516–517 Thermal injury, 103–104 and timing, 515 Index 645

lingual nerve injury (LNI), 502 Vascular lesion, compound nerve injury local analgesia (LA), 503–504 arterio-venous fistula, axilla, 316 management of, 513 catastrophic bleeding, 307 tools, 515 circumferential rupture, 311 mandibular tooth extraction, 513 elbow, 312 medico legal issues, 518–519 emergency arterial repair, 308 neuroplasticity, 517 false aneurysm and arteriovenous fistulae, 313–316 post operative infection, 513 femur and tibia, fracture, 314 prevention of, 521 iatrogenous false aneurysm, 317 reassurance counselling/cognitive iatrogenous ischaemic injury, 319–320 behavioural therapy, 515–516 iatrogenous post ischaemic contracture, 319 signs and symptoms, 503 ischaemia and nerve, 316–318 socket medications, 513 knee, 312–313 surgical technique leaking aneurysm, 310 decompression, 517 multiple fragment wounds, 307 exploration, 517–518 Poiseuille’s law, 312 IAN injuries, 518 proximal humerus, fracture, 310 tissue/neuroma, 518 shoulder, 309–312 third molar surgery supraclavicular plexus and penetrating missile buccal technique, 509–510 wounds, 309 CBCT of, 511 tissue-compartment syndrome, 318 coronectomy, 510–512 traumatic false aneurysms and arterio-venous DPT radiographs, 510 fistulae, 309 juxta apical area, 510 ulnar artery repair, 307 lingual nerve injury, 509 Vascular repair artery/vein, 239 U reversed vein graft, 239, 241, 242 Ulnar nerves, 16, 269–270 Ventral root (VR) in arm and axilla, 266 regeneration, 136 bundles and epineurial vessels of, 53 repair, 403, 411, 412 elbow, 282, 284 Vertebral artery thrombosis, preganglionic injury, 383 extrinsic epineurial vessels of, 53 Vibration injury, 107 hand lesions of, 181 Visceral afferents, 70–71 iatrogenous lesion of, 593 Visual analogue scales (VAS), for pain, 528 proximal stump, 119 Volkmann’s contracture sensory loss, 157 ischaemic, 93 upper limb neuropathies, 208–211 of forearm and intrinsic muscles, 571 distal lesions, 210–211 and supracondylar fracture, 357–358 elbow, 208–211 Wallerian degeneration, 117 W Ulnar neuropathy, elbow Wallerian degeneration anterior transposition, complications of, 285 cervical nerve decompression, 284 distal stump of, 81 transposition, 284 ventral root of, 89 Ultrasonography, preganglionic injury, 398 in ulnar nerve, 117 Upper limb, 175 War wounds, compound nerve injury entrapment syndromes, 284–285 contamination, 304 neuropathies gas gangrene, 305 axillary (circumflex) nerve, 213 missile wounds, leg, 306 brachial plexus lesions, 214–219 principles, 305 long thoracic nerve, 213–214 stages, 305–306 median nerve, 206–208 Wounds radial nerve, 211–212 nerve injury spinal accessory nerve, 213 categories of, 148 suprascapular nerve, 212 system scores, features, 147 ulnar nerve, 208–211 of perineurium, 84–85 Wrist V median and palmar cutaneous nerve, 156 Vascularised graft, 248–249 median neuropathy, 206 sural nerve, failure, 126 primary suture of median nerve, 246 Vascularised ulnar nerve graft (VUNG), 125 recovery function, 411–412 repair technique, 399