PERIPHERAL NERVE DISORDERS

By :

HANANTO WILDAN HABIBI

G0014111
Sebelas Maret of Medical Faculty

Radial Nerve Disorders

Etiology
Injured in the elbow, in the upper arm, or in the
axilla
The Types of Clinical Features
1. Low Lessions
2. High Lessions
3. Very High Lessions

Radial Nerve Disorders

1. Low Lessions
. Etiology: fracture or dislocation at the
elbow, a local wound, Iatrogenic lessions
of the posterior interosseus nerve.
. Clinical Features: Clumsiness, cannot
extend the metacarpophalangeal joint of
the hand, weakness extension and
retroposition of the thumb, wrist extension
is preserved.

Radial Nerve Disorders

2. High Lessions
Etiology: Fracture of the humerus,
prolonged torniquet pressure.
Clinical Features: an obvious wrist
drop, sensory loss is limited to a
small patch on the dorsum around
the anatomical snuffbox.

Radial Nerve Disorders

Radial Nerve Disorders

3. Very High Lessions
Etiology: Trauma or operations around
the shoulder, chronic compression in the
axilla.
Clinical Features: Weakness of the wrist
and hand, the triceps is paralyzed, and
the triceps reflex is absent.

Radial Nerve Disorders

ASSESSMENT
1. The degree of Injury
. The history of the injury, Physical
examination, Electromyography (EMG)
2. Nerve Function
. Sensory and motor function

Radial Nerve Disorders

TREATMENT
1. Open injury
The nerve should be explored
and repaired or grafted as soon as
possible

Radial Nerve Disorders

TREATMENT
2. Closed injury
a. Exploration for a radial nerve injury on
admission before treatment and again after
manipulation or internal fixation.
b. Surgery (Nerve Grafting, Tendon transfer).
c. While recovery is awaited, the small joint of the
hand must be put through a full range of
passive movement. (with splintage)

Radial Nerve Disorders

d. If recovery doesnt occur the disability
can be largely overcome by tendon
transfer: Pronator teres to the short
radial extensor of the wrist; flexor carpi
radialis to the long finger extensor and
palmaris longus to the long thumb
abductor.

Ulnar Nerve Disorders

Etiology
Injuries of the ulnar nerve usually near the
wrist or near the elbow.
The Types of Clinical features
1. Low Lessions
2. High Lessions

Ulnar Nerve Disorders

1. Low Lessions
. Etiology: often caused by cut on shattered
glass, entrapment of the ulnar nerve in the
pisohamate tunnel (guyons canal) by a
deep carpal ganglion or ulnar artery
aneurism.
. Clinical Features: numbness of the ulnar
one and a half finger, Claw hand deformity,
finger abduction is weak, loss of thumb
adduction.

Ulnar Nerve Disorders

2. High Lessions
Etilologi: elbow fracture or dislocation, ulnar
neuritis that caused by compression of the
nerve in the medial epicondylar tunnel.
Clinical features: the hand isnt markedly
deformed, the fingers are therfore less
clawed, motor and sensory are the same
as the low lession

Ulnar Nerve Disorders

Ulnar Nerve Disorders

ASSESSMENT
1. The degree of Injury
. The history of the injury,
examination (e.g.: froments
Electromyography (EMG)
2. Nerve Function
. Sensory and motor function

Physical
sign) ,

Ulnar Nerve Disorders

TREATMENT
a. Exploration for a Ulnar nerve injury on
admission before treatment and again after
manipulation or internal fixation.
b. Surgery (such as nerve repairing, nerve
Grafting, Tendon transfer).
c. Hand physioterapy keeps the hand supple
and useful

Ulnar Nerve Disorders

TREATMENT
Brand Procedure
Tendon transfer from M. Extensor Carpi radialis
longus to Intrinsic Muscle can improve
Metacarpophalangeal flexion.
Zancolli Procedure
Looping a slip of M. Flexor digitorum
superficialis around the opening of the flexor
sheath can also improve Metacarpophalangeal
flexion.

Peroneal Nerve Disorders

Injuries may affect eithe the common
peroneal nerve (lateral popliteal) or one of its
branches the deep or supercial peroneal
nerves.
Clinical Features:
1. The common peroneal nerve
2. The deep peroneal nerve
3. The superficial peroneal nerve

Peroneal Nerve Disorders

1. The common peroneal nerve
. Etiology: damage at the level of the fibular
neck (by severe traction, splintage, and
plaster cast or a ganglion from superior
tibio-fibular joint).
. Clinical features: drop foot, walking with a
high-stepping gait, sensation is lost over the
front and outer half of the leg and the
dorsum of the food. Pain may be significant.

Peroneal Nerve Disorders

2. The deep peroneal nerve
Etiology: anterior compartment syndrome
Clinical features: pain and weakness of
dorsoflexion, sensory loss in small area
of skin between the first and second toes,
paraesthesia and numbness on the
dorsum around first web space if the
distal portion is cut during operation on
the ankle.

Peroneal Nerve Disorders

3. Superficial Peroneal Nerve
Etiology: Lateral compartment syndrome
Clinical features: pain in the lateral part of
the leg and numbness or paraesthesia of
the foot, may be weakness of eversion and
sensory loss on the dorsum of the foot.
The cutaneus branches maybe trapped and
stretched by a severe injury, causing pain
and sensory symptoms without muscle
weakness.

Peroneal Nerve Disorders

ASSESSMENT
1. The degree of Injury
. The history of the injury, Physical
examination, Electromyography (EMG)
2. Nerve Function
. Sensory and motor function

Peroneal Nerve Disorders

TREATMENT
a. Exploration for a peroneal nerve injury on
admission before treatment and again
after manipulation or internal fixation.
b. Surgery (such as Nerve repairing, Nerve
Grafting, Tendon transfer) followed by
splintage to control ankle weakness
c. Tibialis posterior, Permanent Splintage,
or hind foot stabilization if there is no
recovery.

Tibial Nerve Disorders

Etiology:
The tibial (medial popliteal) nerve is rarely injured
except in open wounds. The distal part (posterior
tibial nerve) is sometimes involved in injuries around
the ankle. (can be fracture or dislocation)
Clinical Features:
Unable to plantarflex the ankle or flex the toes,
sensation is absent over the sole and part of the calf,
not much clawing (both intrinsic muscle and long
flexors are involved).

Tibial Nerve Disorders

The posterior tibial nerve gives off a small
calcaneal branch and then divides into
medial and lateral plantar nerve.
The posterior tibial nerve lessions cause
wide sensory loss and clawing of the toes
(intrinsic muscle paralysis, but long
flexors is active)
Injury to one of the smaller branches
causes only limited sensory loss and less
noticable motor weakness.

Tibial Nerve Disorders

ASSESSMENT
1. The degree of Injury
. The history of the injury, Physical
examination, Electromyography (EMG)
2. Nerve Function
. Sensory and motor function

Tibial Nerve Disorders

TREATMENT
a. Exploration for a Tibial nerve injury on admission
before treatment and again after manipulation or
internal fixation.
b. Surgery (such as Nerve repairing, Nerve
Grafting, Tendon transfer) followed by orthosis (to
prevent excessive plantar flexion) and the sole is
protected pressure ulceration.
c. Weakness of plantar flexion can be treated by
hind-foot fusion or transfer of the tibialis anterior
to the back of the foot.

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