Topic 5: Physiotherapy in Peripheral Nerve Injuries PDF

14/02/2023 TOPIC 5 Phyisiotherapy in Periferic Nerves Injuries. 1 NERVE ▪ Epineurium: outermost layer of a nerve. ▪ Perineurium: concentric layers. ▪ Endoneuro: reticular fibres surrounding each nerve fibre. ▪ Axolemma: axonal membrane that surrounds the axon of a nerve fibre. ▪ Schwann cells: mi...

14/02/2023 TOPIC 5 Phyisiotherapy in Periferic Nerves Injuries. 1 NERVE ▪ Epineurium: outermost layer of a nerve. ▪ Perineurium: concentric layers. ▪ Endoneuro: reticular fibres surrounding each nerve fibre. ▪ Axolemma: axonal membrane that surrounds the axon of a nerve fibre. ▪ Schwann cells: minus the C fibres. ▪ Intrinsic and Extrinsic Mobility related to the covering connective tissue. 2 2 1 14/02/2023 DEFINITION of Periferical Nerve Injury (PNI). Partial or complete interruption of normal physiology of the nerve. NERVE CONDUCTION IS AFFECTED. 3 ETIOLOGY • ACUTE Fractures Surgery Electrical burns Traction-elongation • CHRONIC Nerve tunnels compressions Tumors 4 2 14/02/2023 Traumatic Nerve Injury Classification Neuropraxia • Interruption of conduction by compression • Axon preserved • No wallerian degeneration • Motor fiber mor affected than sensory fibers 5 Traumatic Nerve Injury Classification Axonotmesis • Breakdown of axon • Distal Wallerian degeneration :denervation • Motor fibers and sensory fibers affected • Traumatic injury (displaced fractures) 6 3 14/02/2023 Traumatic Nerve Injury Classification Neurotmesis • Complete avulsion of nerve(axon, Schwan,endoneurom) • Distal Wallerian degeneration : denervation • Motor fibers and sensory fibers affected • Traumatic injury (displaced fractures) 7 8 8 4 14/02/2023 Wallerian Degeneration  Active process of retrograde degeneration of the distal end of an axon that is a result of a nerve lesion. It occurs between 7 to 21 days after the lesion occurs • Degenerative changes in the muscle: Tissue atrophy : protein degeneration. Venous stasis, trophic changes. Increases connective tissue : fibrosis Decreases enzymatic activity in muscle • Need support with EET : DENERVATION 9 DENERVATED NERVE ASSESMENT IT Curve . – Reobase. – Galvan-Tétan Theresold – Acomodatión: GTT/reobase • Normal : 3-6. • Partial Den. : 2,7- 1,5. • Total Den.: 1.5-1. • Electromyography 10 10 5 14/02/2023 SYMPTOMS and EVALUATION • • • • • • PAIN LOSS OF SENSATION LOSS OF MOTION LOSS OF POWER TROPHIC CHANGES (skin,,neurovascular,bones,muscles) CONTRACTURES • NERVE is denervated or not ? 11 PHYSIOTHERAPY IN NOT DENERVATED NERVE INJURY Nerve mobility is compromised.: LOW SLIDING MOTION Symptomatology: PAIN : ➢ Burning: vascular compression. ➢ Stabbing: mechanical compression. Provocation test: Tinel. Anaesthesia +++ and dysaesthesia. 12 12 6 14/02/2023 • Treatment of Pain : analgesic electrotherapy. • Electrostimulation. + Active contraction • Manual treatment of nervous release : Neurodynamics techniques (Butler& Shalock): Nerve mobilization regarding the structure that locks . Indicated to eliminate restrictions . • Contraindicated in : Inflammation or acute trauma . Severe impairment of sensitivity. Butler D. Mobilization of Nervous System, Melbourne Ed. 1991. 13 13 NERVE INJURIES WITH DENERVATION Phase I (until muscular activity is obtained) GOAL INTERVENTION DECREASE OEDEMA –Compressive elastic bandage. –Circulatory massage and DLM. –Active/passive mobilisation PAIN CONTROL. – TENS. – Interferential currents MUSCLE MAINTAINANCE –Excitomotor Electrotherapy –MOBILIZATION PREVENT JOINT STIFFNESS –Passive and active assisted kinesitherapy. –Use of corrective and dynamic orthoses. 14 14 7 14/02/2023 NERVE INJURIES WITH DENERVATION Phase II GOAL INTERVENTION INCREASE MUSCULAR STRENGHT FUNCTIONAL REHABILITATION TREATMENT OF AFTER-EFFECTS 15 15 8