NERVE & TENDON injuries

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Presentation transcript:

NERVE & TENDON injuries Dr.H.Saremi Orthopaedic surgeon, Hand & Shoulder fellowship Hamedan university of medical sciences Besat Hospital

Peripheral nerve injury Common Results of remain modest(only 50% regaining usefull function

Internal topograpy Sanderland1945,a complexnetwork of branching and intermingling fascicles that consantly change throughout the course of the nerve Complex in proximal Distal fascicles can be dissected over long distances before merging occurs

Neuronal degeneration and regeneration Any part of the neuron detached from its nucleous degenerates and is destroyed by phagocytosis Faradic stimulation can be obtained for periods of 18-72h

Neuronal degeneration and regeneration Fragmentation and shrinkage Clearing of axonal debries is complete after 15-30 days Axonal sprouting may occur within the first 24 h after injury Stamp neuroma or neuroma in continuity

Classification of nerve injuries(seddon1943) Neuropraxia :edema or breakdown of a localized segment of the myelin sheath,recovery in afew days or weeks Axonotemesis:breakdown of the axon and wallerian degeneration .schwan cell and endoneurial tubes preserved Neurotmesis complete anatomical severance of the nerve

Classification of nerve injuries(sunderland1951)

Assessment after recovery

Factors that influence regeneration after neurorraphy Age Gap between nerve ends Delay between time of the injury and repair Level of injury Condition of the nerve ends Experience and technique of the surgeon

technique

Type of injuries

Radial nerve

Radial nerve Results of repair:89%proximal muscles,63% all musclesm,36%fine control of extensores Critical limit of delay:15 m no motor recovery,PIN9 m

Ulnar nerve

Ulnar nerve Results or repair:78:% useful motor recovery,5%independent motion of interossei,30%s3 Critical limit of delay9m in high lesions 15 m in low lesions,sensory 29m

Nerve transfer

Median nerve

Median nerve Results of repair:82%-90%good and fair motor recovery,97% sensory recovery Critical time of delay:sensory and intrinsic muscles:9 m in high lesions,12 m in low lesions

Flexor tendon injuries

Flexor tendon injuries

Flexor tendon injuries

Flexor tendon injuries

Flexor tendon injuries Post operative care Kleinert:active ex--------passive flx Duran: controled passive motion with dorsal blocking of the finger

Flexor tendon injuries

Extensor tendon injuries

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