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Nerve

Injuries

NERVE INJURIES (NEUROPATHY) TREATMENT IN DUBAI

It is sometimes referred to as peripheral neuropathy, which involves damage to the peripheral nervous system. This is the network of nerves outside the brain and spinal cord. If this network is damaged, it disrupts the ways the neurons communicate with each other and with the brain.

Symptoms: Patient may experience temporary or permanent numbness; a tingling, prickling, or burning sensation; increased sensitivity to touch; pain; muscle weakness or wasting; paralysis, loss of coordination, sexual function problems, weight loss, or sweating too much.

UPPER EXTREMITY ENTRAPMENT:

  1. BRACHIAL PLEXUS INJURY
    • The most common cause is trauma
    • Sharp burning pain in the shoulder with transient weakness
    • Erb palsy- newborns during a difficult delivery, with upper trunk mostly affected
    • Causes: complications upon birth, trauma, tumors and cancer treatments or sports activities
    • Complications: stiff joints, numbness, disability, muscle atrophy
    • Treatment: proper positioning, range of motion, and strengthening exercise
  2. MEDIAN NERVE INJURY- aka Carpal Tunnel Syndrome
    • Presented with pain and paresthesia involving the thumb and index finger more intense at night and relieved by shaking the hand
    • Decreased sensation of some or all fingers innervated by the median nerve except at the area of thenar eminence and palm which is spared
    • atrophy of thenar eminence of the thumb
    • the weakness of APB, Opponents Pollicis and 1st and 2nd lumbricals
    • A motor deficit on thenar muscles especially abduction and opposition
    • Sensory deficit main manifestation loss in 5th digit
    • Etiology: Pregnancy, Rheumatoid Arthritis, anomalies in muscle and tendon, gout, acromegaly (disorder from excess growth hormone after the growth plates have closed), trauma, infection, scleroderma, and multiple myeloma
    • Diagnosis: EMG studies are useful in confirming the diagnosis of CTS and assessing its severity
    • Treatment: activity modifications, the wrist splinted in 0–5 degrees of extension, oral NSAIDs, local corticosteroid injections, and surgical decompression
  3. RADIAL NERVE INJURY
    • Injured at the spiral groove of humerus (bone in the arm) -it is seen in fractures of the humerus or with external compression of the nerve
      1. wrist or finger drop and mild weakness of elbow flexor muscles. Abnormal sensation in the back of the hand and first four fingers
      2. If there is no recovery within 8–10 weeks, surgery is recommended. If there is no return of function after 1 year, tendon transfer is considered. During the recovery period, a “cock-up” splint may be needed.
    • Posterior interosseous neuropathy- occur with entrapment of the radial nerve at the arcade of Frohse (elbow) or as a result of elbow fractures or external compression
      1. Presented with discomfort or pain over the proximal and lateral aspect of the forearm
      2. A motor deficit in the branches of radial nerve below the elbow, sparing the branches above the elbow
  • Weakness is seen in the finger extensors, supinator muscle, and extensor carpi ulnaris, sparing brachioradialis function, and hand sensation.
  1. ULNAR NERVE INJURY
    • Injured at the elbow – most common focal neuropathy; risk factors include repetitive elbow flexion, repetitive gripping, external pressure over the ulnar groove, older age, male gender, and smoking
      1. Dysesthesias (abnormal sense of touch) and sensory changes over the ulnar aspect of the hand and forearm. As the disease advances, patients lose hand dexterity and grip strength.
      2. Avoid powerful grip, prolonged or repetitive elbow flexion
    • Injured at the wrist- nerve entrapment at the Guyon canal in the wrist between the hook of the hamate and the pisiform bone
      • altered sensation in the fourth and fifth digits and weakness of all the ulnar-innervated hand muscles
      • (+) partial claw hand
  1. MUSCULOCUTANEOUS NERVE INJURY
    • loss of sensation on the outside of the forearm especially the lateral side caused by compression and weight lifting activities but it is rarely seen
    • weak elbow flexion and supination of the arm
  2. AXILLARY NERVE INJURY
    • Can result from a shoulder dislocation, fractures on the surgical neck of humerus and scapula; seen on people whose using crutches
    • Pain at the back of the shoulder
    • Sensory loss over the deltoid area loss of shoulder abduction and weak shoulder flexion-extension
  3. LONG THORACIC NERVE INJURY
    • Pain around the base of the neck, deltoid, and scapula
    • Injured by spasm of the middle scalene muscle, carrying a heavy backpack, furniture movers, or during radical breast operations
    • Also, result in inability to abduct arm above 90 degrees and disruption of the scapulohumeral rhythm due to the loss of scapular rotation
    • Medial winging of the scapula due to serratus anterior paralysis

LOWER EXTREMITY ENTRAPMENT:

  1. FEMORAL NERVE INJURY
    1. usually injured within the retroperitoneal space or under the inguinal ligament after iatrogenic (illness caused by medical examination or treatment) injuries and presents with one-sided thigh weakness and numbness of the anterior thigh and medial leg.
    2. If the nerve is compressed within the pelvis, hip flexion can also be affected. If the weakness is severe, a knee-ankle-foot orthosis may be indicated
    3. (+) pain during knee extension
    4. Instability around the knee & buckling – difficulty stairs & inclines
  2. LATERAL FEMORAL CUTANEOUS NERVE INJURY
    1. Aka “meralgia paresthetica,” which presents with numbness or hyperesthesia (abnormal increase in sensitivity to stimuli of the sense) in the nerve’s territory
    2. There’s no possible weakness on the muscles
    3. It is caused by compression at the anterior superior iliac spine (ASIS) and the inguinal ligament, obesity, pregnancy, diabetes, wearing tight waistbands, or surgery within proximity of the nerve.
  3. FIBULAR (PERONEAL) MONONEUROPATHIES
    1. Most common nerve injury in the lower extremity
    2. Causes: prolonged compression at the fibular head due to bedrest, unsuitable splinting, or tumor; prolonged squatting, knee trauma, and anterior compartment syndrome.
    3. a weakness of ankle dorsiflexion that results in premature foot slap or steppage gait; Sensation is diminished in the lower two-thirds of the lateral leg and dorsum of the foot.
    4. Prevention: avoiding prolonged knee flexion and habitual leg crossing, and fitting the patient with an ankle-foot orthosis to improve the gait
  4. TARSAL TUNNEL SYNDROME
    1. Compression of the tibial nerve or its branches underneath the flexor retinaculum at the level of the ankle
    2. with pain and paresthesia that radiate from the sole of the foot and heel, mostly unilateral
    3. can results in atrophy of intrinsic muscles
    4. gait deviation (limping)
    5. Causes: space-occupying masses, localized tumors, bony prominences, and a venous plexus within the tarsal canal.
  5. SCIATIC NERVE INJURY
    1. Causes: hip fractures, posterior hip dislocations, and hip surgeries; prolonged sitting
    2. the mild ache to a sharp, burning sensation or excruciating pain radiates from the lower spine to buttock and down the back of the leg, usually one side only
    3. numbness or weakness in the affected leg or foot

 

 

DIAGNOSTIC TOOLS FOR NERVE INJURIES

 

  1. NERVE CONDUCTION STUDIES
    1. Done by a neurologist with an electromyogram that evaluates the electrical conduction on the peripheral nerves
    2. Used to assess nerve damage, check for damage caused by diabetes, peripheral neuropathy, conditions affecting the nervous system or trapped nerves
  2. NEEDLE EMG
    1. Measures the electrical activity of the muscle

It detects any signs of blocking or slowing down of responses to nerve stimulation

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