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Types of Nerve Injury and Diagnostic Evaluation: Nagashree V

This document discusses the classification and diagnosis of nerve injuries. It describes Seddon's and Sunderland's classifications of nerve injuries based on etiology and anatomy. Diagnosis involves clinical assessment of motor and sensory functions as well as electrophysiological tests like nerve conduction studies, electromyography, and somatosensory evoked potentials to evaluate nerve damage.

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Nagashree V
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141 views32 pages

Types of Nerve Injury and Diagnostic Evaluation: Nagashree V

This document discusses the classification and diagnosis of nerve injuries. It describes Seddon's and Sunderland's classifications of nerve injuries based on etiology and anatomy. Diagnosis involves clinical assessment of motor and sensory functions as well as electrophysiological tests like nerve conduction studies, electromyography, and somatosensory evoked potentials to evaluate nerve damage.

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Nagashree V
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Types of nerve injury and

diagnostic evaluation
Nagashree V
Classification
• Etiologic
• Anatomic
– Seddon’s classification
– Suderland’s calssification
Aetiologic
• Mechanical injury
• Crush injury
• Laceration
• Stretch
• thermal injury
• Infectious
• Malignancy
• Metabolic diseases
• Radiation
• Iatrogenic
• Chemical injury
• Occupational disorders
• Birth trauma
Grade 6- complex peripheral
nerve injury
Seddon’s classification
Diagnosis
• Clinical assessment
• Motor
– Muscle testing
– TINEL’S SIGN
• Sensory
– Two point discrimination
– Touch
– Pin Prick-Nocicepton
– Thermal discrimination
• Reflexes
• Autonomic
– Sweating, pilomotor response, Vasomotor parlysis
• Trophic changes
– Skin, Finger nails
– Osteoporosis
TINEL SIGN
SEMMENS WEINSTEIN MONOFILAMENT
THERMAL TESTING
TWO POINT DISCRIMINATION
REFLEXES
VASOMOTOR RESPONSE
TROPHIC CHANGES-SKIN
TROPHIC CHANGES- NAILS
MRC grading of sensory nerve dysfunction
MRC grading of muscle power
Electrophysiological
• Nerve Conduction Studies-NCV
– SNAP-Sensory Nerve Action Potential
– CMAP-Compound Motor Action Potential
• EMG- Electromyography
• SSEP-Somatosensory evoked potential
Motor nerve conduction study
Compound Motor Action Potential

Nerve Conduction
Velocity=PML-DML
Antidromic sensory nerve conduction study
Orthodromic sensory nerveconduction study
Sensory Nerve Action Potential
Electromyography
Motor Unit Action Potential

Normal

Chronic Nerve lesion


Early reinnervation -
Nascent units

Late reinnervation
Satellite Potential
SOMATOSENSORY EVOKED POTENTIAL
SUMMARY
• Conduction block
– Preserved sensory and motor nerve conduction in
distal segment
– Reduced amplitude depending on the severity
• Axonal block
– Reduced or Absent SNAP and CMAP
– Normal NCV
– Fibrillations in EMG

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