Dr Massud Wasel MD DO ND BSc(Hons) P.G.C.A.P

Slides:



Advertisements
Similar presentations
Carpal Tunnel Syndrome
Advertisements

Michael D. Weaver, DO Physical Medicine & Rehabilitation Sports Medicine October 16, 2013.
Wrist Orthopaedic Tests
Compressive Neuropathy of the Upper Extremity ::::
Neurology Chapter of IAP Guillain-Barre’. Neurology Chapter of IAP Guillain-Barre’ Syndrome Post-infectious polyneuropathy; ascending polyneuropathic.
Module 3b: NERVE FUNCTION IMPAIRMENT Module 3b: NERVE FUNCTION IMPAIRMENT.
  Segmental demyelination  Dysfunction of the Schwann cell or damage to the myelin sheath  Axonal degeneration and reinnervation of muscle  Wallerian.
Clinical Aspects of Peripheral Nerve and Muscle Disease Roy Weller Clinical Neurosciences University of Southampton School of Medicine.
An Approach to Peripheral Neuropathy
HAND. Deep Fascia -Flexor retinaculum -Palmar aponeurosis -Palmaris brevis m.
Peripheral Neuropathy Dr.Shamekh M. El-Shamy. Peripheral Neuropathy Peripheral Neuropathy  DEFINITION: It is inflammation and degeneration of the peripheral.
Neuromuscular disorders
PERIPHERAL NEUROPATHY
Peripheral Neuropathy
DR TATHEER ZAHRA ASSISTANT PROFESSOR ANATOMY NERVES OF UPPER LIMB & THEIR LESIONS.
Peripheral Nerve Injuries Ulnar, median and common peroneal nerves.
Carpal Tunnel -Surag Khadka. Contents Anatomy Borders and Contents Carpal Tunnel Syndrome Causes Signs and Symptoms Diagnostic tests Management and Treatment.
Ulnar nerve palsy NORTON UNIVERSITY SURGICAL SEMIOLOGY Ass Prof. SEANG Sophat.
Carpal Tunnel Syndrome. Definition: It's a compresion of median nerve in the carpal tunnel is called carpal tunnel syndrome.
Tingling Fingers Doug Campbell Consultant Hand Surgeon, Leeds
The Hand Dr Idara C. Eshiet.
By Dr. Vohra & Dr. Sanaa Al-Shaarawy
SPINAL NERVE ROOT COMPRESSION AND PERIPHERAL NERVE DISORDERS Group A – AHD Dr. Gary Greenberg.
This lecture was conducted during the Nephrology Unit Grand Ground by a Sub-intern under Nephrology Division, Department of Medicine in King Saud University.
radial nerve ulnar nerve median nerves
Diarrhea and Neuro Sx Seizures (shigella) Blurred vision, diplopia, dysarthria, dysphagia, descending paralysis (Clostridium botulinum Headache, dizziness.
Chronic inflammatory demyelinating polyneuropathy (CIDP) This polyneuropathy develops over weeks or months, usually with a persistent but relapsing and.
DISEASES OF THE PERIPHERAL NERVOUS SYSTEM
Group A – AHD Dr. Gary Greenberg
Department of Neurology, The 2nd affiliated hospital, kunming Medical College Yinfengqiong.
 Clinical condition where pressure on peripheral nerve produces dysfunction in the nerve.  Carpal Tunnel Syndrome (wrist – median nerve)  Cubital Tunnel.
Periphral neuropathy. Peripheral Neuropathy Peripheral nerves are composed of sensory, motor, and autonomic elements. Diseases can affect the cell body.
Peripheral Neuropathy Clinical Management Course February 12, 2007
symptoms  Pain:  eg. Localized to radial side; tenosinovitis of the thumb tendons (De Quervain’s disease).  Localized to ulnar side; inferior radio-ulnar.
Wang FC, Tinant F, Tomasella M CHU de Liège, Belgique.
Charcot-Marie- Tooth Disease Jessica Tzeng. History  Named after Jean-Martin Charcot, Pierre Marie (Charcot’s pupil), and Howard Henry Tooth  Not a.
Prof Saleh WaslAllah Alharby
PERIPHERAL NERVE INJURIES
Peripheral Neuropathy : describes disorders of peripheral nerves, including the dorsal or ventral nerve roots; dorsal root ganglia; brachial or lumbosacral.
Peripheral nerve disease Peripheral nerve disease.
The Neuromuscular Manifestations of Amyloidosis
DIABETIC NEUROPATHY PAWUT MEKAWICHAI MD DEPARTMENT OF MEDICINE MAHARAT NAKORNRAJSIMA HOSPITAL.
CASE PRESENTATION BY JYOTHIS THANKAM. H ISTORY A male patient named Pradeep 35 yr old a manual labourer hailing from a low socioeconomic status came with.
陳京瑜.  Inflammatory  Infectious  Hereditary  Acquired metabolic and toxic  Traumatic  Tumor.
Uremic Neuropathy Nephrology R4 박미나. Uremic Polyneuropathy Uremic Polyneuropathy.
Multiple Sclerosis. Multiple sclerosis (MS) is a disease that affects central nervous system (brain and spinal cord). It damages the myelin sheath. 
Upper Limb- Blood & nerve supply; effects of nerve injury G.LUFUKUJA1.
Electromyography in Clinical Practice A Case Study Approach
Radiculopathy and Plexopathy Radiculopathy and Plexopathy Dr Massud Wasel M.D D.O. N.D Registered osteopath P.G.C.A.P Fellow of Higher Education Academy.
The wrist and the hand. Wrist anatomy Radius forms wrist joint with scaphoid, lunate & triquetrum.
Presented by: Mary L. Dombovy, MD, MHSA Paul K. Maurer, MD Anthony L. Petraglia, MD Patrick J. Reid, MD Matthew L. Dashnaw, MD, Pharm D M. Gordon Whitbeck,
Hand and Elbow Diagnosis and Initial Management Claire Wright
DISEASES OF PERIPHERAL NERVES
Guillain-Barre Syndrome
Symptom Scenario: Tingling
Hand Palsy.
Mononeuritis Multiplex:
Peripheral nerve injuries
Uremic neuropathy 신장내과 R2 장준용.
Peripheral Neuropathy
CHAPTER 21 COMPRESSION NEUROPATHIES
Peripheral Nerves Examination
Peripheral Lesions of the Arm: Focus on the Hand
27/11/2018.
Carpal Tunnel Syndrome
Peripheral nerver damage
PEREHHRAL NERVOUS SYSTEM
BY ANUJA.C. The radial nerve is a continuation of posterior cord of brachial plexus in the axilla. It is a largest branch of the brachial plexus It supplies.
Coordination, sensory and peripheral system
Presentation transcript:

Dr Massud Wasel MD DO ND BSc(Hons) P.G.C.A.P Neurology Dr Massud Wasel MD DO ND BSc(Hons) P.G.C.A.P

NEUROPATHY A pathological process affecting peripheral nerve system Pathology: Demyelination Axonal degeneration Compression Infarction infiltration

Mononeuropathies Caused by peripheral nerve compression Carpal nerve syndrome Idiopathic Hypothyroidism DM Pregnancy RA Obesity Acromegaly

Clinical features Tingling in fingers(esp. at night) Weakness of thenar muscles Wasting of thenar muscles Weakness of abductor pollicis brevis (raising thumb away from palm) Weakness of opposition of thumb and little finger Tinel’s sign(tapping over carpal tunnel) Sensory loss of palm

management Splint wrist Surgical decompression OMT

Ulnar nerve compression Usually occurs after trauma of elbow Clinic: Wasting and weakness of interossei and hypothenar muscles Sensory loss inn the ulnar distribution

Radial nerve compression Saturday night palsy Clinic: Wrist drop Weakness of finger extension

Mononeuritis multiplex (multiple mononeuritis) Aetiology : DM Leprosy Vasculitis Sarcoidosis Malignancy Neurofibromatosis HIV infection

Polyneuropathies Guillain-Barre syndrome: Acute inflammatory post-infective polyneuropathy Follows 1-3 weeks after infection(often trivial,or compylobacter infection) Clinic: Weakness of distal limb muscles+- numbness Weakness ascends over days for up to 3 weeks Can affect repiratory & facial muscles in 30%

Investigations: Diagnosis is made on clinical grounds Nerve conduction studies CSF(cell count normal,protein raised 1-3g/l)

Management: Measurment of respiratory function(art. Blood gases,vital capacity,FEV1) Assisted ventilation if necessary) I.V gama-globulin Plasmapheresis Heparin for prevention of thromboembolism Prognosis:spontaneous gradual recovery

Other polyneuropathies Metabolic: DM,uraemia, Toxic:alcohol,drugs(phenytoin,isoniazid,metronidazole) Vitamin deficiencies thiamin (B1),pyridoxine(B6), B12, nicotinic acid

Vitamin B12 deficiency (sub acute combined degeneration of the cord) Aetiology: Low dietary intake(vegan diet) Impaired absorption (lack of intrinsic factor): pernicious anaemia, gastrectomy, congenital lack of intrisic factor Impaired absorption (small bowel): pancreatic insufficiency, terminal ileal disease, bacterial overgrowth-bacterial utilization of B12 Abnormal metabolism:transcobalamin II deficiency-congenital lack of B12 transporter

Clinic: Distal sensory loss(light touch,vibration, joint position sense) Absent ankle jerk Optic atrophy Dementia

Investigations: Reduced serum B12 Macrocytosis Megaloblastic bone marrow Management:Parenteral B12

Peroneal muscular atrophy (Charcot-Marie-Tooth disease) Inherited sensorimotor neuropathy Several types:autosomal dominant and recessive Clinic: Distal limb wasting&weakness Pes cavus Clawing of toes Loss of sensation Loss of reflexes

Autonomic neuropathy Aetiology:DM,Guillain-Barre syndrome,amylodosis Clinic: Postural hypotension Retentions of urine Impotence Diarrhoea Diminished sweating Cardiac arrhythmias