Radial nerve injury
- 1. Eunice Susan Thomson -40
- 2. INJURY TO RADIAL NERVE RADIAL NEUROPATHY OR RADIAL NERVE PALSY Neuropraxia – compression Axonotmesis – disruption of axon Neurotmesis –complete disruption of nerve
- 3. ANATOMY Largest branch Arises from – posterior cord of brachial plexus
- 5. COURSE
- 6. Leaves axilla via triangular space Lie along the spiral groove along with profunda brachii artery Pierces lateral intermuscular septum to enter the anterior compartment of arm Divides into terminal branches Motor supply : long head of triceps Motor supply : medial and lateral head of triceps, aconeus Sensory supply : post. Cutaneous nerve of forearm,lower lateral cutaneous nerve of forearm Motor supply : brachialis ,brachioradialis Posterior interosseous nerve and superficial radial sensory nerve
- 7. ETIOLOGY Humeral fractures – during fracture or during surgery Gun shot injury Injuries with sharp object Iatrogenic – upper limb surgery
- 8. Prolonged application of tourniquet Crutch palsy Intramuscular injections Compression neuropathies Saturday night paralysis
- 10. MOTOR DEFICIT Wrist drop Inability to extend and radially abduct the thumb Difficulty in straightening elbow Difficulty in making a fist Inability to grasp
- 12. CLASSIFICATION OF INJURY High radial nerve palsy - in radial groove Low radial nerve palsy –around the elbow
- 14. WARTENBERG SYNDROME Compression of superficial branch of radial nerve Between extensor carpi radialis longus and brachioradialis Numbness – posterior aspect of the thumb
- 15. POSTERIOR INTEROSSEOUS NERVE SYNDROME Compression of PIN – radial tunnel Causes : Trauma Lipoma Septic arthritis Pain and weakness of extensors of digits
- 16. RADIAL TUNNEL SYNDROME Compression of PIN Pain Tenderness
- 17. DIAGNOSIS Muscle strength and function Triceps Brachioradialis TESTING FOR TRICEPS STRENGTH
- 18. Wrist extensors – Unable to extend Partial paralysis - contraction of Extensor carpi radialis and Extensor carpi ulnaris Extensor digitorum - metacarpo-phalangeal joints Extensor policis longus – inter-phalangeal joint of thumb
- 19. Electromyography Recording electric activity of muscle Nerve conduction studies Velocity of conduction of impulse in nerve
- 20. TREATMENT CONSERVATIVE Splintage of paralysed limb : Radial nerve palsy – Cock-up splint
- 21. COCK-UP SPLINT
- 22. Preserve mobility of joints – full ROM once daily Maintain hygiene – skin and nails
- 23. Physiotherapy Massage of paralysed muscles Passive exercises Developing partially affected muscles Analgesics
- 24. SURGERY- indications High impact nerve injury Severe neuropathic pain Lack of response to conservative management Indifference to Tinnel test
- 26. NERVE REPAIR Primary nerve repair Secondary nerve repair
- 27. Nerve repair Primary nerve repair (1 week) Immediate primary nerve repair : clean nerve cut with limited injury Delayed primary nerve repair : wound contaminated Wound is debrided 2 nerve ends are approximated with fine silk sutures prevent retraction Definitive repair (2 weeks)
- 28. SECONDARY NERVE REPAIR INDICATIONS : Nerve lesions presenting some time after injury Syndrome of incomplete interruption Syndrome of nerve irritation Failure of conservative treatment (3 weeks)
- 30. NERVE SUTURE Epi-neural suture Epi- perineural suture Perineural suture Group fascicular repair
- 31. NERVE GRAFTING Nerve gap > 10cm Expandable nerve (Sural nerve) is sutured to 2 ends
- 33. NEUROLYSIS Nerve freed from enveloping scar – PERINEURAL FIBROSIS Longitudnal dissection to relieve pressure from fibrous tissue within nerve – INTRANEURAL FIBROSIS
- 35. TENDON TRANSFERS Correct : Instability Imbalance Lack of co-ordination Redistributing muscular forces – restore function
- 36. ARTHRODESIS Surgically immobilising a joint by fusing the bones Not preferred
- 37. PROGNOSIS Age Tension at suture line Time since injury Location of injury Condition of nerve ends Associated condition – infection , ischemia
- 38. REFERENCE NATARAJAN ‘S TEXTBOOK OF ORTHOPAEDICS AND TRAUMATOLOGY MAHESHWARI ‘S ESSENTIAL ORTHOPAEDICS