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Peripheral nerves & Brachial Plexus

The human nervous system can be divided into the:
Centra Nervous system (Brain, spinal cord)
 Peripheral nervous system

Brachial plexus is the network of nerves that sends signals from the spinal cord to the shoulder, arm and hand. It originates from the ventral rami of C5,C6,C7.C8, and T1 spinal nerves (Roots). as they progress they branch into the cords (medial, posterior, lateral) and finally form the terminal branches or peripheral nerves.

Peripheral nerves can be compared to highly sophisticated cables, that relay information between your brain and the rest of your body.
The peripheral nervous system is divided into two main parts:
 Autonomic nervous system (ANS): Controlsinvoluntary bodily functions and regulates glands.
 Somatic nervous system (SNS): Controls musclemovement (motor function) and relays information from ears, eyes and skin (sensory function) to the central nervous system.

Brachial Plexus Lesions
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What are the reasons for peripheral Nerve Injuries

Peripheral nerves can be damaged in several ways:

  • Injury by cut, crush or acute and chronic (Carpal Tunnel syndrome) compression
    Infection (leprosity/Hanson`s disease, …)
  • Metabolic Disorders: Diabetes, mucopolysaccharoid, …)
  • Medical conditions: Pregnancy, Renal failure (dialysis patients), …)
  • autoimmune Diseases (Guillain-Barre syndrome, Lupus, Rheumatoid arthritis and Sjogren's syndrome, ….)
  • Intoxications, ……

Symptomes of peripheral nerve lesions

Peripheral nerves may have motor, sensory and autonimic functions, which may be impaired to different degrees.

Motor function

Damage to these nerves is typically associated with
– muscle weaknes (palsy)
– muscle cramps
– uncontrollable muscle twitching

Sensory function

Damage to sensory nerves is typically associated with:
– altered touch
– alterted temperature
– pain

Autonomous function

Damage to autonomic nerves can be associated with activities that are not controlled consciously, such as
breathing, the heart, thyroid function, and digestion, which can result in secondary complications secondary to:
– excessive sweating
– changes in blood pressure
– inability to tolerate heat
– gastrointestinal symptoms

Multidisciplinary Patient Care

Only through an intensive interdisciplinary Cooperation can achieve an optimal therapy result be reached. Therapy team members are :

Hand Surgery (often in conjunction with the neuropathologist)

  • Physiotherapy
  • Neurology
  • Radiology
  • Anesthesia & Pain Clinic (deafferentation pain, causalgia, …)
  • Internal Medicine (Diabetes, Dialysis, ….)
  • Social services/employment office/professional association (professional rehabilitation or reintegration)
  • Orthopedic technician (sleeve and splint apparatus)
  • Mental support
  • Patient support groups

The constant exchange of information (Telephone calls, medical reports) within the team is exceptional Importance. An optimal treatment result can only be achieved if all members of the therapy team work together seamlessly.

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Integrated Treatment Concept according to BERGER

Prof. Dr. Robert Hierner is a reference in the field of interdisciplinary and multi-professional treatment of peripheral nerve lesions.
For the treatment of lesions of peripheral nerves, the so-called “integrative therapy concept according to BERGER” is used. It comprises:

  • Primary nerve reconstruction (primary nerve suture/coaptation, nerve transplantation, ….)
  • Secondary muscle replacement surgeries (Tendon transfer, free functional muscle transplantation, …)
  • (tertiary) adjuvant interventions
    The duration of therapy depends on the type of lesion from 2 – 6 weeks up to 3 – 5 years. During this period is a physiotherapeutic Basic therapy – in different form and
    intensity – is Indispensable requirement
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Acute Nerve Injury

nerve changes

Chronic Nerve Compression (Carpal Tunnel Syndrome)

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Old nerve lesion (long standing nerve palsy)

Brachial Plexus Lesions

Brachial Plexsus Lesions