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Compressive Neuropathies

NERVE INJURY     [Back To Top] 

Pathological processes

Usually neuropraxia +/- axonotmesis with different fibres damaged by varying degrees

Neuropraxia
  • Seddon 1942
  • Reversible physiological nerve conduction block
  • Segmental demyelination due to compression
  • causes loss of some types of sensation and muscle power
  • recovers within days or weeks
Axonotmesis
  • Axonal disruption but endoneurium and nerve in continuity.
  • Wallerian degeneration of axons occurs
  • Axonal regeneration within hrs, 1-3mm/day
  • Target organs atrophy, if not reinnervated within 2 yrs, don't recover
Double Crush Syndrome
  • Proximal entrapment makes nerve susceptible to effects of more distal entrapment

MEDIAN NERVE

Median nerve Anatomy     [Back To Top] 

  • From C5,C6,C7,C8,T1
  • Condensation of lateral & medial cords of brachial plexus
  • Travels lateral to brachial artery in arm, but crosses medial to artery in antecubital fossa
  • No branches before elbow
  • Between 2 heads of pronator teres at the elbow
  • 5-6cm distal to elbow gives off anterior interosseous branch (motor to FPL, FDP index finger & pronator quadratus)
  • Proceeds betw. FDS & FDP
  • Palmar cutaneous branch (sensory to thenar skin) arises 5cm proximal to wrist joint & overlies flexor retinaculum
  • Enters carpal tunnel betw. PL & FCR
  • Recurrent motor branch to thenar muscles arises at distal end of carpal tunnel


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