The lecture has been given on Feb. & Mar. 26th, 2011 by Dr. Bakhtyar.

1. Peripheral nerve injuries

2. Structure of the nerve Axon myeline sheath Schwann cell layer Endoneurium Perineurium Epineurium

3. Pathology The nerve is injured by: Ischaemia Compression Traction Laceration burning

6. Neurotmesis Division of the nerve trunk Occurs in open wounds Neural tubes are destroyed A Neuroma is formed( regenerating fibers + Schwann cells + fibroblasts) Function may be adequate but is never normal even after surgical repair.

7. Diagnosis Symptoms : (1) Numbness (2) Tingling (3) Weakness Signs: (1) Abnormal posture ( wrist drop) (2) Atrophy of the muscles (3) Change in sensibility Tinels sign : shows progression in nerve recovery Electrodiagnostic tests (1) level of injury (2) Severity (3) progress of nerve recovery

9. In the HAND always try to repair to regain at least protective sensation

13. Erb’s palsy: Injury of C5+ C6 The arm is held to the side, internally rotated, and pronated. (i.e paralysis of the abductors and external rotators of the shoulder + the supinators)

16. Klumpke’s palsy: Less common The arm is flail and pale All muscles of the fingers are paralyzed ± Ipsilateral Horner’s syndrome

17. Treatment: If there is no biceps recovery by 3 months, surgery is performed: If the roots are not avulsed: Nerve graft If the roots are avulsed : Nerve transfer If severe internal rotation : Subscapularis release ± tendon transfer OR Rotation osteotomy of the humerus Physiotherapy in all cases Prognosis in Klumpke’s palsy is poor.

19. Axillary nerve injury (C5) Supplies (1) Deltoid (2) Skin over the lower ½ of the deltoid. Injured in (1) Shoulder dislocation (2) # of humeral neck Clinically (1) Loss of abduction (2) Numbness over the deltoid.

22. Treatment: Spontaneous recovery during 8 weeks. If not: Exploration + repair OR graft. If failed: Tendon transfer OR Shoulder arthrodesis. .