Median and Ulnar Nerves Traumatic Injuries Rehabilitation
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Ulnar Claw-Hand Related Neglected Post-Traumatic Anterior Shoulder Joint Dislocation
Open Access Library Journal 2017, Volume 4, e3454 ISSN Online: 2333-9721 ISSN Print: 2333-9705 Ulnar Claw-Hand Related Neglected Post-Traumatic Anterior Shoulder Joint Dislocation Hermawan Nagar Rasyid Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Teaching Hospital, Bandung, Indonesia How to cite this paper: Rasyid, H.N. Abstract (2017) Ulnar Claw-Hand Related Neglected Post-Traumatic Anterior Shoulder Joint Shoulder joint is the most frequently dislocated joint. Humeral head disloca- Dislocation. Open Access Library Journal, tion pushed the nerve toward medial side. Neglected shoulder dislocation is 4: e3454. difficult to manage and requires extensive procedures to obtain good func- https://doi.org/10.4236/oalib.1103454 tional outcome. In the case of negligence, it is often found loss of the anterior Received: February 13, 2017 capsule due to absorption of the capsule. Nerve lesions, in particular the ulnar Accepted: March 17, 2017 nerve, often do not receive attention. Clinically, it often occurred from neura- Published: March 20, 2017 praxia to severe condition like claw-hand deformity. In my experience of a Copyright © 2017 by author and Open neglected case, there was a 53-year-old woman who presented to the ortho- Access Library Inc. paedic clinic with a left anterior shoulder fracture dislocation following a fall This work is licensed under the Creative onto the right shoulder and upper right arm. She had treated herself at home Commons Attribution International for around six months before visiting the clinic. She also complained of some License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ deformities on her ring and little fingers, known as ulnar claw-hand. -
Physical Therapy Improved Hand Function in a Patient with Traumatic Peripheral Lesion: a Case Study
American Medical Journal 3 (2): 161-168, 2012 ISSN 1949-0070 © 2012 Science Publications Physical Therapy Improved Hand Function in a Patient with Traumatic Peripheral Lesion: A Case Study 1,2 Marco Orsini, 2,3 Julio Guilherme Silva, 3Clynton Lourenco Correa, 4Diego Rogrigues, 5Acary Bulle Oliveira, 4Valeria Marques Coelho, 4Debora Gollo, 1Antonio Marcos da Silva Catharino, 6Dionis Machado, 6Victor Hugo do Vale Bastos, 1Marco Antonio Araujo Leite, 7Gabriela Guerra Leal Souza, 1Carlos Henrique Melo Reis and 2Sara Lucia Silveira de Menezes 1Departament of Neurology, Nova Iguacu University, Hospital Geral de Nova Iguacu, Nova Iguacu, RJ, Brazil 2Master’s Program in Science of Rehabilitation, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, RJ, Brazil 3Department of Medical Clinic, Faculty of Medicine, School of Physiotherapy, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil 4Fluminense Rehabilitation Association, Niteroi, RJ, Brazil 5Department of the, Neuromuscular Disease Federal University of Sao Paulo (UNIFESP), Vila Mariana, Sao Paulo, Brazil 6Department of the Physical Therapy Federal University of Piaui (UFPI), Parnaiba, Piaui, Brazil 7Department of Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto, MG, Brazil Abstract: Problem statement: Nerves are frequently injured by traumatic lesions, such as crushing, compression (entrapment), stretching, partial and total extraction, resulting in damages to the transmission of nerve impulses and to the reduction or loss of sensitivity, to the motility and to the reflexes of the innervated area. The objective of this study was to evaluate the results of a rehabilitation program that lasted three months in the process of traumatic injury recovery of the median and ulnar nerves in a 52 year-old patient. -
Classification of Finger Posture in Drop Finger Due to Cervical Foraminal Stenosis: a Mini-Review
hysical M f P ed l o ic a in n r e u & o R J l e a h International Journal of Physical n a b o i t i l i a ISSN: 2329-9096t a n r t i e o t n n I Medicine & Rehabilitation Mini Review Classification of Finger Posture in Drop Finger Due to Cervical Foraminal Stenosis: A Mini-Review Mitsuru Furukawa1*, Michihiro Kamata2 1Department of Orthopedic Surgery, Murayama Medical Center, Tokyo, Japan; 2Department of Orthopedic Surgery, Keiyu Hospital, Kanagawa, Japan ABSTRACT Few reports have been published examining cervical foraminal stenosis as the cause of drop finger. This mini-review, therefore, will provide a summary of the findings of articles published on this topic, written in both English and Japanese. Cervical foraminal stenosis is difficult to diagnose from imaging findings alone; thus, physical examination findings are often needed to make a firm diagnosis. Numbness of the fingers, the extent of interscapular pain, and finger posture can be used to differentiate drop finger due to cervical foraminal stenosis from other diseases. It is crucial to provide sufficient explanation to the patient before a decompression surgery is performed because the recovery of muscle strength is often incomplete and the improvement may be small. Keywords: Drop finger; Cervical foraminal stenosis; C7 nerve root; C8 nerve root ABBREVIATIONS: RESULTS CFS: cervical foraminal stenosis; PION; Posterior Interosseous The search obtained three case reports, one clinical feature, and Nerve; ECR; Extensor Carpi Radialis; EDM; Extensor Digiti one surgical outcome from PubMed, whereas two case reports Minimi; EIP; Extensor Indicis Proprius and two reviews came from the Japan Medical Abstracts Society. -
Hand Surgery: a Guide for Medical Students
Hand Surgery: A Guide for Medical Students Trevor Carroll and Margaret Jain MD Table of Contents Trigger Finger 3 Carpal Tunnel Syndrome 13 Basal Joint Arthritis 23 Ganglion Cyst 36 Scaphoid Fracture 43 Cubital Tunnel Syndrome 54 Low Ulnar Nerve Injury 64 Trigger Finger (stenosing tenosynovitis) • Anatomy and Mechanism of Injury • Risk Factors • Symptoms • Physical Exam • Classification • Treatments Trigger Finger: Anatomy and MOI (Thompson and Netter, p191) • The flexor tendons run within the synovial tendinous sheath in the finger • During flexion, the tendons contract, running underneath the pulley system • Overtime, the flexor tendons and/or the A1 pulley can get inflamed during finger flexion. • Occassionally, the flexor tendons and/or the A1 pulley abnormally thicken. This decreases the normal space between these structures necessary for the tendon to smoothly glide • In more severe cases, patients can have their fingers momentarily or permanently locked in flexion usually at the PIP joint (Trigger Finger‐OrthoInfo ) Trigger Finger: Risk Factors • Age: 40‐60 • Female > Male • Repetitive tasks may be related – Computers, machinery • Gout • Rheumatoid arthritis • Diabetes (poor prognostic sign) • Carpal tunnel syndrome (often concurrently) Trigger Finger: Subjective • C/O focal distal palm pain • Pain can radiate proximally in the palm and distally in finger • C/O finger locking, clicking, sticking—often worse during sleep or in the early morning • Sometimes “snapping” during flexion • Can improve throughout the day Trigger Finger: -
Respiratory Management in the Patient with Spinal Cord Injury
Hindawi Publishing Corporation BioMed Research International Volume 2013, Article ID 168757, 12 pages http://dx.doi.org/10.1155/2013/168757 Review Article Respiratory Management in the Patient with Spinal Cord Injury Rita Galeiras Vázquez,1 Pedro Rascado Sedes,2 Mónica Mourelo Fariña,1 Antonio Montoto Marqués,3,4 and M. Elena Ferreiro Velasco3 1 Critical Care Unit, Complexo Hospitalario Universitario A Coruna,˜ CP. 15006, A Coruna,˜ Spain 2 Critical Care Unit, Complexo Hospitalario Universitario de Santiago de Compostela, CP. 15702, Santiago de Compostela, Spain 3 Spinal Cord Injury Unit, Complexo Hospitalario Universitario A Coruna,˜ CP. 15006, A Coruna,˜ Spain 4 Department of Medicine, University of A Coruna,˜ CP. 15006, A Coruna,˜ Spain Correspondence should be addressed to Rita Galeiras Vazquez;´ [email protected] Received 30 April 2013; Revised 11 July 2013; Accepted 30 July 2013 Academic Editor: Boris Jung Copyright © 2013 Rita Galeiras Vazquez´ et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Spinal cord injuries (SCIs) often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Vital capacity (VC) is an indicator of overall pulmonary function; patients with severely impaired VC may require assisted ventilation. It is best to proceed with intubation under controlled circumstances rather than waiting until the condition becomes an emergency. -
11 Peripheral Nerve Injuries
11 Peripheral Nerve Injuries Done By: Reviewed By: Nada Alouda Manar Aleid COLOR GUIDE: • Females' Notes • Males' Notes • Important • Additional Objectives 1. Brachial plexus injuries. 2. Peripheral nerve injuries: - Axillary nerve. - Musculocutaneous nerve. - Radial nerve. - Median nerve. - Ulnar nerve. 1 Peripheral Nerve Injuries (PNI): Sunderland-Classification of Peripheral Nerve Injury: Type1: Conduction block (neurapraxia) “Only myelin sheath”. Type2: Axonal injury (axonotmesis). Type3: Type2 + Endoneurium injury. Type4: Type3 + Perineurium injury. Type5: Type4 + Epineurium Complete cut of the nerve injury (neurotmesis). General Approach to a Patient with PNI or Hand Injury: History Physical Examinaon InvesJgaon Consultaon Treatment • 1. Hand dominance. • Sensory. • Nerve conducon • Physiotherapy. • Compression: 2. Occupaon (it will study (NCS). splint, give NSAIDs, affect the Tx). & modify lifestyle. • Occupaonal 3. Hobbies. • Motor. If no improvement • MRI (in space- therapy. • Main Complaint: within 3 months--> occupying lesion). 1. Sensory. • Specific tests. surgical 2. Motor. • Splint / Range of (decompression, 3. -/+ Pain. moon. nerve • HPI: transposiJon, & - Site. - Onset. - tendon transfer). Duraon. - Mechanism of injury. • Trauma or - Progression of laceraon symptoms. (emergency): nerve • Risk Factors: The repair, nerve gra, physician should make sure if it is nerve transfer and injury or not tendon transfer. (compressive): - Trauma. - Previous surgery. 2 Brachial Plexus Injuries: Basic Anatomy: • It is formed from the union of the anterior rami of the 5th, 6th, 7th, 8th cervical and 1st thoracic nerves (C5, C6, C7, C8, and T1). • The plexus is divided into Roots, Trunks, Divisions, Cords and terminal Branches. ! Classification of Brachial Plexus Injuries: • Open injuries (stab wounds or gunshot wounds): - Can be at any level (roots, trunks, divisions, etc.). - Classified into: o Supraclavicular (roots, trunks, divisions). -
Nerve Injury Classifications – Seddon's and Sunderland's
The Pain Source Makes Learning About Pain, Painless http://thepainsource.com Nerve Injury Classifications – Seddon’s and Sunderland’s Author : admin By Chris Faubel, MD -- Understanding nerve injury classification is essential for prognostic value clinically. Some basic anatomy, along with the two classification systems, and their corresponding EMG findings need to be learned and remembered. Two classification systems exist (and are frequently tested in various exams): 1. Seddon's classification (neuropraxia, axonotmesis, neurotmesis) 2. Sunderland's classification (types 1-5) To understand the systems, you must first review some basic nerve anatomy. There are three connective tissue layers in the CNS and PNS. 1. epineurium 2. perineurium 3. endoneurium Individual nerve fibers (single axons) are covered with varying amounts of myelin and then covered by endoneurium. These individually wrapped nerve fibers are then grouped into bundles of fibers called fascicles, which are covered by perineurium. Finally, groups of fascicles are bundled together to form the peripheral nerve (such as the median nerve), which is covered by epineurium. Seddon's classification: Neuropraxia 1 / 3 The Pain Source Makes Learning About Pain, Painless http://thepainsource.com Physical Medicine & Rehabilitation Board Review - Sara Cuccurullo, MD refers to local myelin injury with the axon still intact and functional motor > sensory fibers affected considered a temporary paralysis of the nerve fiber least severe injury usually from crush injury or ischemia Electrodiagnostic -
Peripheral Nerve Regeneration and Muscle Reinnervation
International Journal of Molecular Sciences Review Peripheral Nerve Regeneration and Muscle Reinnervation Tessa Gordon Department of Surgery, University of Toronto, Division of Plastic Reconstructive Surgery, 06.9706 Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; [email protected]; Tel.: +1-(416)-813-7654 (ext. 328443) or +1-647-678-1314; Fax: +1-(416)-813-6637 Received: 19 October 2020; Accepted: 10 November 2020; Published: 17 November 2020 Abstract: Injured peripheral nerves but not central nerves have the capacity to regenerate and reinnervate their target organs. After the two most severe peripheral nerve injuries of six types, crush and transection injuries, nerve fibers distal to the injury site undergo Wallerian degeneration. The denervated Schwann cells (SCs) proliferate, elongate and line the endoneurial tubes to guide and support regenerating axons. The axons emerge from the stump of the viable nerve attached to the neuronal soma. The SCs downregulate myelin-associated genes and concurrently, upregulate growth-associated genes that include neurotrophic factors as do the injured neurons. However, the gene expression is transient and progressively fails to support axon regeneration within the SC-containing endoneurial tubes. Moreover, despite some preference of regenerating motor and sensory axons to “find” their appropriate pathways, the axons fail to enter their original endoneurial tubes and to reinnervate original target organs, obstacles to functional recovery that confront nerve surgeons. Several surgical manipulations in clinical use, including nerve and tendon transfers, the potential for brief low-frequency electrical stimulation proximal to nerve repair, and local FK506 application to accelerate axon outgrowth, are encouraging as is the continuing research to elucidate the molecular basis of nerve regeneration. -
Resident Manual of Trauma to the Face, Head, and Neck
Resident Manual of Trauma to the Face, Head, and Neck First Edition ©2012 All materials in this eBook are copyrighted by the American Academy of Otolaryngology—Head and Neck Surgery Foundation, 1650 Diagonal Road, Alexandria, VA 22314-2857, and are strictly prohibited to be used for any purpose without prior express written authorizations from the American Academy of Otolaryngology— Head and Neck Surgery Foundation. All rights reserved. For more information, visit our website at www.entnet.org. eBook Format: First Edition 2012. ISBN: 978-0-615-64912-2 Preface The surgical care of trauma to the face, head, and neck that is an integral part of the modern practice of otolaryngology–head and neck surgery has its origins in the early formation of the specialty over 100 years ago. Initially a combined specialty of eye, ear, nose, and throat (EENT), these early practitioners began to understand the inter-rela- tions between neurological, osseous, and vascular pathology due to traumatic injuries. It also was very helpful to be able to treat eye as well as facial and neck trauma at that time. Over the past century technological advances have revolutionized the diagnosis and treatment of trauma to the face, head, and neck—angio- graphy, operating microscope, sophisticated bone drills, endoscopy, safer anesthesia, engineered instrumentation, and reconstructive materials, to name a few. As a resident physician in this specialty, you are aided in the care of trauma patients by these advances, for which we owe a great deal to our colleagues who have preceded us. Additionally, it has only been in the last 30–40 years that the separation of ophthal- mology and otolaryngology has become complete, although there remains a strong tradition of clinical collegiality. -
Axonotmesis of the Sciatic Nerve
Diagnostic and Interventional Imaging (2012) 93, 398—400 LETTER / Neurology Axonotmesis of the sciatic nerve a,∗ b c c M. Ohana , S. Quijano-Roy , F. Colas , C. Lebreton , c c C. Vallée , R.-Y. Carlier a Radiology Department, Nouvel Hôpital Civil, Strasbourg University Hospitals, 1, place de l’Hôpital, 67000 Strasbourg, France b Paediatrics Department, Raymond-Poincaré Hospital, 104, boulevard Raymond-Poincaré, 92380 Garches, France c Radiology Department, Raymond-Poincaré Hospital, 104, boulevard Raymond-Poincaré, 92380 Garches, France Case report KEYWORDS Peripheral nerve; We report the case of an eight-year old girl who was admitted for aftercare and rehabilita- MRI; tion one month after a serious head injury that required a four-day stay in intensive care. Axonotmesis Initial investigations did not show any evidence of post-traumatic injury. During her admission, she developed significant pain in the left buttock radiating to the lower limb associated with a sensorimotor deficit. These disabling pains persisted at rest. The clinical examination revealed that the patient had great difficulty walking, presenting a limp, a tender point on palpation of the left buttock radiating to the thigh and the leg along a posterolateral course, with hyperaesthesia in the whole area. Extension of the leg and both flexion and extension of the foot were impossible; hip flexion was normal. Hypoaesthesia was noted on the inside of the left leg and foot. The left patellar and Achilles reflexes were absent. Vital signs were normal. First-line magnetic resonance imaging (MRI) of the lumbar spine did not reveal any abnormalities. An MRI of the pelvis and lower limbs was then carried out and this highlighted involve- ment of the sciatic nerve along its whole extra-perineal course (Fig. -
Respiratory Management in the Patient with Spinal Cord Injury
Hindawi Publishing Corporation BioMed Research International Volume 2013, Article ID 168757, 12 pages http://dx.doi.org/10.1155/2013/168757 Review Article Respiratory Management in the Patient with Spinal Cord Injury Rita Galeiras Vázquez,1 Pedro Rascado Sedes,2 Mónica Mourelo Fariña,1 Antonio Montoto Marqués,3,4 and M. Elena Ferreiro Velasco3 1 Critical Care Unit, Complexo Hospitalario Universitario A Coruna,˜ CP. 15006, A Coruna,˜ Spain 2 Critical Care Unit, Complexo Hospitalario Universitario de Santiago de Compostela, CP. 15702, Santiago de Compostela, Spain 3 Spinal Cord Injury Unit, Complexo Hospitalario Universitario A Coruna,˜ CP. 15006, A Coruna,˜ Spain 4 Department of Medicine, University of A Coruna,˜ CP. 15006, A Coruna,˜ Spain Correspondence should be addressed to Rita Galeiras Vazquez;´ [email protected] Received 30 April 2013; Revised 11 July 2013; Accepted 30 July 2013 Academic Editor: Boris Jung Copyright © 2013 Rita Galeiras Vazquez´ et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Spinal cord injuries (SCIs) often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Vital capacity (VC) is an indicator of overall pulmonary function; patients with severely impaired VC may require assisted ventilation. It is best to proceed with intubation under controlled circumstances rather than waiting until the condition becomes an emergency. -
Tendon Transfers for Nerve Palsies
Tendon Transfers for Nerve Palsies Comprehensive Hand Review Course American Association of Hand Surgeons Annual Meeting, Friday January 23rd, 2015 Atlantis in Paradise Island, Bahamas Amy M. Moore, MD Washington University School of Medicine I. Introduction Functional deficits after nerve injury are determined by the specific nerve involved and location of the injury. Reconstruction of function after nerve injury is dependent on time from injury, presence of concomitant injuries (bone and soft tissue) and availability of donors (i.e. redundancy of function). Definition: Tendon transfer – transfer of a functional muscle-tendon unit to replace a lost or missing muscle-tendon unit in order to restore motion or balance to the wrist and/or hand. II. Principles In order for successful return of function, certain principles should be considered: Tissue Equilibrium: Resolution of Wound Healing, Bony Union, and Correction of Contractures Local tissue should be in optimal condition: soft, mobile, no evidence of induration Full passive joint ROM is necessary preoperatively . This may require contracture releases, therapy and splinting Avoid transfers across scar tissue and skin grafted areas. Plan incisions to place tendon junctions beneath flaps rather than beneath incisions or scars Expendable Donor Avoid downgrading function with unacceptable donor loss Patients’ needs vary for “priority” Goal: maintain at least one wrist flexor (not PL alone), wrist extensor, extrinsic finger flexor and extensor. Adequate Strength Goal: balance of power Consider: lost muscle strength, donor muscle strength and remaining counterbalance strength Force is proportional to muscle cross sectional area at resting length Expect the muscle to lose one grade of strength after transfer Try to avoid using previously denervated muscle Appropriate Excursion Tendon Excursion must match for function Proportional to fiber length Methods to Augment “effective” Excursion: .