1. PERIPHERAL NERVE INJURIES Dr. Mansoor Khan, MBBS, FCPS I, Resident Surgery, KTH, Peshawar

2. A N A T O M Y Connective tissue (epineurium, perineurium, endoneurium) Nerve tissue (axon, schwann cell)

4. A N A T O M Y EPINEURIUM PERINEURIUM ENDONEURIUM VESSELS

5. PERRIPHERAL NERVE INJUIES NERVE INJURIES Acute injury Chronic injury

6. N e u r o p r a x i a Mildest form, reversible conduction block (function loss), for hours or days due to direct mechanical compression, ischemia, mild burn trauma or stretch

7. A x o n t m e s i s Axonal and myelin sheath disruption while fascicular integrity is maintained--Wallerian degeneration occurs (prognosis is good—days, weeks)

8. N e u r o t m e s i s Laceration from sharp or blunt forces causing complete disruption of the axon and supporting connective tissue---very poor prognosis without surgical repair

11. C l i n i c a l S i g n s Motor function, Tinel’s sign (positive-sensory function negative (after 4-6weeks)-total interruption, Sweating-sympathetic fiber, Sensory function

12. Muscle atrophy start : post-injury 1 month peak : 3rd - 4th month

13. C h r o n i c N e r v e E n t r a p m e n t Paresthesia Loss of function Pain

14. P a t h o p h y s i o l o g y Direct compression Segmental demyelination Wallerian degeneration(distal) Ischemia Swelling of nerve Microcompartment SD

16. C a r p a l T u n n e l S y n d r o m e

17. PREGNANCY TYPE WRITING

18. PAIN & PARASTHESIA DISTRIBUSION

19. RELEASE SURGERY

21. SUPRA-CONDYLAR FRACTURE anterior displacement M E D I A N N E R V E

22. Radial Nerve Entrapment Posterior Interosseous Nerve Syndrome

23. Radial Nerve Entrapment Posterior Interosseous Nerve Syndrome

24. RADIAL NERVE INJURY Fracture of shaft of humrus

25. RADIAL NERVE INJURY WRIST DROP

26. GUYON’S CANNAL SYNDROME U L N A R N E R V E

27. CUBITAL TUNNEL SYNDROME U L N A R N E R V E

28. CUBITAL TUNNEL SYNDROME U L N A R N E R V E

29. Benediction posture CLAWING OF RING & LITTLE FINGER U L N A R N E R V E

30. FROMENT’S SIGN Flexior pollicus longus (median nerve) compensates for a weak adductor pollicis (ulnar nerve) U L N A R N E R V E

31. CUBITAL TUNNEL SYNDROME Ulnar nerve Release surgery U L N A R N E R V E

32. COMMON PERONEAL Fracture of the head of fibula

33. PERONEAL NERVE INJURY SYMPTOMS Decreased sensation, Slapping gait, foot drop, toes drag

34. FACIAL NERVE Anatomy

35. FACIAL NERVE Anatomy

36. FACIAL NERVE PALSY LOSS OF FRONING, DROOPING, EYEBROW DROP

37. C o n s e r v a t i v e t r e a t m e n t Indications Short history, mild-moderate, intermittent, reversible cause (pregnancy, oral contraceptive, endocrine abnormalities, type writer) Method Non-steroidal anti-inflammatory drugs, splint

38. T r e a t m e n t Time of operation Open injury Closed injury Early intervention Delayed intervention Delayed intervention

39. S u r g i c a l I n d i c a t i o n s Failed conservative treatment Severe injury (sensory loss, muscle atrophy, motor weakness)

40. E p i n e u r a l R e p a i r

41. F a s c i c u l a r R e p a i r

42. N e r v e G r a f t