peripheral nerve injuries

injuries, syndromes and conditions

horner's syndrome

a neurological condition that disrupts the sympathetic nerve pathway and effects the eyes and face tissues

sympathetic nerve function?

these nerves control involuntary fucntions, like sweating and pupil dilation and constriction

horner's syndrome presentation

• bloodshot eyes

• upper eyelid droop

• lack / increase of facial sweating

• constricted pupils

• effecting one side of face

physio for nerve injuries

• soft tissue, rom

• splints

• aqua therapy

• TENS ~ muscle weakness

• aerobic exercise ~ axonal growth

• sensory / functional deficits ~ fine motor tasks, balance, proprioception

• emotional stress ~ QoL, depression, anxiety, sleep

burner 'stinger' syndrome

transient brachial plexus neuropraxia

mechanism of injury is forceful separation of head and shoulder (stretch) or forceful closure facets (compression)

• fall from a motorbike 

• direct blunt force trauma ~ being kicked

burner syndrome recovery and management

• recovery is severity dependent ~ can take weeks, months 

• management involves ROM, strengthening, posture correction and avoiding long term functional decline  

long thoracic nerve (LTN) 

a branch of the brachial plexus arising from C5, C6, C7. this nerve innervates the serratus anterior muscle, which is involved in scapular movement and respiration

LTN palsy / injury

it is a long, thin and superficial muscle that descends along the chest wall, so it is vulnerable to injury and trauma

how can LTN be damaged?

• direct injury

• overuse injury - heavy load bearing activity, scaleni compression

• inflammatory conditions ~ Parsonage-Turner syndrome

LTN palsy clinical presentation

damage to nerve can lead to serratus anterior paralysis = scapula winging

• reduced shoulder flexion / abduction

• weakness and pain during overhead activities 

Parsonage-Turner syndrome

an inflammatory condition of the brachial plexus 

spinal accessory nerve (SAN) 

a cranial nerve that innervates the sternocleidomastoid and upper trapezius muscle. arises from upper spinal cord C1 - C5/6

sternocleidomastoid / trapezius function

the sternocleidomastoid muscle enables rotation and flexion of the head and neck

the trapezius muscle controls shoulder shrugging and scapula movement

SAN palsy / injury

is a long, thin and superficial muscle so can easily be injured through trauma:

• blow to the neck

• whiplash

• heavy manual work

SAN palsy clinical presentation 

• pain in the neck, upper back, arms

• weakness of the shoulder ~ trapezius atrophy ‘shoulder droop’

• limited shoulder AROM ~ normal PROM

• slower nerve conduction tests

SAN palsy management

• physio ~ maintain range, restore strength

• prescribed pain relief

• traumatic injury may require surgery if no improvement within 3 months

suprascapular nerve

originates from C5-C6 brachial plexus and provides motor function to supra + infra spinatus muscle as well as sensory innervation to shoulder joint

suprascapular nerve injury / presentation

• most commonly injured by hyperabduction movements ~ sports, baseball, tennis

• presentation: shoulder pain, weakness and atrophy of both muscles 

• conservative treatment - surgery if this fails

axillary nerve

originates from brachial plexus C5-C6 roots

• sends motor info to deltoid and teres minor 

• sends sensory info to lateral upper arm 

axillary nerve injury and management

• most common cause is acute trauma ~ shoulder dislocation or fracture

• location = the nerve is susceptible to injury

• conservative management: ROM, strengthen, posture correction, avoid functional decline - surgery if complete damage