Download - Peripheral Nerve-blok Neuromuscular
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
1/42
PERIPHERAL NERVE
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
2/42
BRACHIAL PLEXUS LESION
Brachial plexus is a complex structure originatingfrom C5-T1 nerveroots.
Trauma : most common cause of brachialplexopathy.
Closed injuries typically produce injury due totraction on the plexus, such as after a fall.
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
3/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
4/42
ERB PALSY
In injuries that cause head & shoulder to bestretch apart such as in newborn deliveries orfalls on shoulder, result in upper trunkplexopathies with involvement ofC5-C6-C7erb palsy.
Waiters tip deformity :Shoulder : adduction, internal rotation
Elbow : extention, supination
Wrist : flexion
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
5/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
6/42
KLUMPKE PALSY
Injury in which there is forceful upward tractionon arm, result in lower trunk plexopathies affect
C8-T1 fibers
klumpke palsy.
Clinical presentation : hand weakness
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
7/42
DIAGNOSE
Anamnesa : Trauma ?
Physical Exam. : MMTSensory
Reflexes
Supporting Exam. : NCV / EMG
MRI (tumor ?)
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
8/42
TREATMENT
Positioning
ROM exercise
Strengthening exercise
Orthoses : shoulder sling, splint
Electro Stimulation : MMT < 3
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
9/42
CARPAL TUNNEL SYNDROME
Contents of carpal tunnel include :
-Median nerve.
-Flexor pollicis longus-Four tendons each from flexor digitorumsuperficialis & profundus muscles.
Swelling or increased pressure inside carpaltunnel lead to compression ofmedian nerve,producing symptoms of CTS
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
10/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
11/42
Clinical presentation
Paresthesias (numbness, tingling, and burning)involving median nerve distribution (first 3digits).
Deep aching pain in hand & wrist. Pain willradiate info forearm, even rarely to shoulder.
Patient might report subjective swelling of
hand but on inspection, no swelling is usuallyapparent.
Nocturnal worsening of symptoms is common
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
12/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
13/42
Clinical presentation
Flick sign : patient often report awakening withhand paresthesias, which are then relieved by
shaking involved hand.
Advance CTS : sensory symptoms last longer orbecome persistent, & thenar weakness develops.
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
14/42
CTS is often associated with repetitive hand &wrist movements or the use of vibrating
machine. The great majority of cases are idiopathicin
origin.
Predispose / risk factor :
-DM -RA
-Amyloidosis -Obesity
-Hypothyroidism -Pregnancy
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
15/42
PHYSICAL EXAMINATION
Abnormality in median sensory testing.
MMT is more advance cases show weakness and
atrophy of Abductor Pollicis Brevis & OpponensPollicis Muscles.
Provocative test : Tinels sign, Phalens sign,Prayer sign
Flick sign
Supporting examination : NCV / EMG
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
16/42
TREATMENT
ROM exercise
Strengthening exercise
Nocturnal wrist splint : hold the wrist in 0-30 of extension.
USD / Phonoporeses / Laser
Medication : NSAID, Corticosteroidinjection
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
17/42
POLIOMYELITIS
is a viral infection involving the anterior horncells (LMN), producing weakness in affectedbulbar and/or spinal myotomes.
Clinical presentation :
-Initial symptoms : fever, malaise, headache,
gastrointestinal or upper respiratory tracksymptoms.
-Weakness was typically asymmetric, morecommon in the lower extremities
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
18/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
19/42
Patient with history of polio infection maydevelop fatigue and worsening muscle weakness
severe years or even decades after initialinfection.
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
20/42
POST POLIO SYNDROME
Criteria for establishing a diagnosis :
Confirmed history of paralitic polio
Partial to fairly complete neurologic & functionalrecovery
Periode of neurologic & functional stability for atleast 15 years.
No other medical explanation for the newhealthproblems
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
21/42
Onset of 2 or more of following symptoms sinceachieving stability :
-Unaccustomed fatique.-New weakness in muscle previously affectedand/or unaffected
-Muscle and/or joint pain
-Functional loss
-Cold intolerance
-New atrophy
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
22/42
TREATMENT
ROM exercise
Strengthening exercise
Endurance exercise Orthoses : HKAFO
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
23/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
24/42
BELLS PALSY
idiophatic peripheral fascial nerveparalysis.
Risk factor :
-DM -Hyperacusis
-HT -Lack of lacrimalis
-Pregnancy -Schizophrenia
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
25/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
26/42
TREATMENT
Acute (day of 0-4) :
HEP : warm compress, fascial massage.
HE : sunglasses, Y-plester Day of > 4 :
-SWD / Laser
-ES
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
27/42
HERNIATED NUCLEUS PULSOSUS
A disk injury in which the nuclear pulposusmigrates through the annular fibers.
A higher prevalence occurs for the lumbarregion at the L4-L5 or L5-S1 followed bythe C5-C6 disc.
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
28/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
29/42
CLASSIFICATION
Buldging disc
Prolapsed disc
Extruded disc
Sequestered disc
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
30/42
ETIOLOGY
Spontaneous
Lifting activities
Coughting / sneezing
Bending / twisting activity
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
31/42
CLINICAL PRESENTATION
Acute neck or back discomfort radiatingdown the upper or lower limb
Weakness, numbness, paresthesias or painsecondary to chemical or mechanical stimuli tothe disc or nerve root.
Exacerbation occurs with lumbar motion
(forward flexion, extention), sitting, sneezing,coughing, valsava manuver
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
32/42
DIAGNOSTIC STUDY
X rays
MRI
Myelography
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
33/42
TREATMENT
Acute : relative rest
Diathermi : MWD, SWD, USD
Laser TENS
Traction : cervical, lumbal
Orthoses : Lumbar corset HEP : William Flexion Exercise
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
34/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
35/42
LEPROSY (HANSENS DISEASES)
Etiology : Mycobacterium Leprae
Onset : Immune status dependent
Clinical presentation :-Most common world-wide neuropathy
-Sensory abnormality
-Drop hand, drop foot-Fascial palsy
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
36/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
37/42
SIGN OF LEPROSY
A slowly growing patch on the skin that does notitch or hurt
Tingling numbness, or some loss of feeling inthe hand & feet. Or definite loss of feeling inskin patches.
Slight weakness or deformity in hand & feet
Enlargement of certain nerves, with or withoutpain or tenderness.
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
38/42
DIAGNOSE
Definite loss or change of feeling in skinpatches.
Definite enlargement of nerves. Presence of leprosy bacilli in a skin smear
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
39/42
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
40/42
TREATMENT
Long term medical treatment : to control the leprosyinfection as early as possible Dapsone, Rifampisin,Clofazimine.
Emergency treatment (when necessary to control) &prevent further damage (from leprosy reaction).
Safety measures, aids, exercise, & education toprevent deformities (sores, burns, injuries, contractures).
Social Rehabilitation. Work with individual, parent,schools, & community to create a better understandingof leprosy, to lessen peoples fear, & to increaseacceptance, so child & adult with leprosy can lead a full,happy, meaningful life
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
41/42
REHABILITATION OF LEPROSY
ROM exercise
Stretching exercise
Strengthening exercise ES
Orthesa : Knuckle bender, dorsal spring
HEP : Soaking-Oiling-Scrapping HE : sunglasses, glove, shoes/sandal
-
7/30/2019 Peripheral Nerve-blok Neuromuscular
42/42
THANK YOU