Peripheral Nerve Disorders
Peripheral Nerve Disorders
Peripheral Nerve Disorders
NERVE
DISODERS
Ken Wirastuti
Bagian IP.Saraf-FK.UNISSULA
node of Ranvier.
Disorders of Nerve
Cell
Tendonitis
Spring 2006
IEOR 170
[Chung]
(mild)
(moderate)
(severe)
3 classes of injury
Class 1 conduction block (by e.g. transient ischemia
(rapidly reversible) or paranodal demyelination),
recovery occurs in wks (mild structural damage with
loss of small areas of myelin around nodes of Ranvier)
Regeneration
Outgrowth
of multiple sprouts
from distal end of axon
(regenerating cluster)
Slow process (1 mm/day) limited
by rate of slow component of axonal
transport (tubulin, actin and
intermediate filaments)
CAUSA
Major categories:
Entrapment Neuropathy
CARPAL TUNNEL
SYNDROME
Anatomi:
The shaded area represents the area usually affected by carpal tunnel
syndrome. As you can see, it can and usually does involve half of your
ring finger as well as your palm and first 2 fingers. In some people a part
of the thumb may also be involved.
(Photograph courtesy of Christopher-Patrick Photography, Winston-Salem, NC)
Tinel sign. Have someone hold your hand with your wrist bent slightly back.
With the other hand, your assistant should tap on your wrist as shown. If you
experience pain, numbness, or tingling while they are tapping, you may have
carpal tunnel syndrome. You can also perform this on yourself by tapping on
your wrist as shown in the picture. Having someone else bend your wrist back
slightly is a little more effective. (Photograph courtesy of Christopher-Patrick
Photography, Winston-Salem, NC)
DIFFERENTIAL
DIAGNOSIS
A splint or brace
NSAIDs.
Cortisone injections.
Surgery: open incision
or endoscopic.
Spring 2006
IEOR 170
[Chung]
31
Diagnosis:
1.
Anamnesis:
Daily activities?
Past injuries?
X ray ?
3. MRI ?
2.
Terapi:
1.
Conservatif (non-surgical)
Modifikasi aktivitas
Medikasi: obat anti inflamasi
(NSAID)
Brace
Terapi fisik: exercise
Steroid injection
2.
Surgery
Diagnosis :
Diagnosis :
Pemeriksaan
Test Finkelstein
Pasien
ulnar
de Quervains Disease
Chronic tenosynovitis due to
narrowed tendon
sheaths around
abductor policis
longus and
extensor pollicis
brevis muscles
Frozen shoulder /
Adhesivecapsulitis
Frozen
shoulder is a
disorder where the
connective tissue
surrounding the
glenohumeral joint of
the shoulder becomes
inflamed and stiff and
abnormal bands of
tissue form restricting
motion and causing
chronic pain.
Plantar Fasciitis
Policeman's
Plantar Fasciitis
Differential diagnosis
Repetitive
a lot
Benign tumors or cysts
Bone spurs
Nerve ganglion
Fracture
Systemic conditions: alcoholism, diabetes
mellitus, rheumatoid arthritis, thyroid
disorders
Diagnosis
Symptomps
EMG
Treatment
Rest
NSAID
Steroid
injection
surgical
Peroneal Palsy
Drop Foot
The inability to lift the front part of the foot.
Paralysis of anterior muscles of lower leg
Inability to dorsiflex at the ankles and toes
Causes the toes to drag along the ground while
walking.
Can happen to one or both feet at the same
time.
It can strike at any age.
Temporary or permanent
Causes
Injury
sports injuries
diabetes
hip orknee replacementsurgery
spending long hours sitting cross-legged or squatting
childbirth
large amount of weight loss
Injury
Neurological
sclerosis (MS)
cerebral palsy
Charcot-Marie-Tooth disease
Conditions
dystrophy
amyotrophic lateral sclerosis (Lou Gehrigs disease)
polio
Rupture
of Anterior Tibialis
Fracture of fibula
Compartment Syndrome
Diabetes
Alcohol Abuse
SYMPTOMS
Difficulty
Sensory Symptomp
Superfici
al
peroneal
IMAGING
X-Ray
Post-Traumatic - tibia/fibula and ankle - any bony
injury.
Anatomic dysfunction (eg. Charcot joint)
Ultrasonography
If bleeding is suspected in a patient with a hip or
knee prosthesis
Electromyelography
(EMG)
This study can confirm the type of
neuropathy, establish the site of the lesion,
estimate extent of injury, and provide a
prognosis.
Sequential studies are useful to monitor
recovery of acute lesions.
TREATMENT
Depends
block
Amitriptyline
Nortriptyline
Pregabalin
Gabapentin
Laproscopic
Synovectomy
SPECIFIC TREATMENT
Braces
or splint
Brace on the ankle and foot or splint
that fits into the shoe can help to hold
the foot in the normal position
Surgical
Physical Therapy
Exercises
Maintain
Improve