Nerve and Tendon Injuries

Question 1

What is neurapraxia?

Answer 1

Continuity of the nerve is maintained but it has been stretched to the point of injury (bruised). The prognosis is generally good.

Question 2

What is axonotmesis?

Answer 2

Endoneurium intact (tube in continuity) but there is a disruption of axons. A stretch of 15% or more is enough to cause this. Wallerian degeneration follows (it degenerates back then regrows).
Prognosis is fair. Sensory recovery is often better than motor-not normal but enough to recognise pain, hot & cold, sharp and blunt.

Question 3

What is neurotmesis?

Answer 3

Complete nerve division by laceration or avulsion.
No recovery unless repaired (by direct suturing or grafting).
Endoneural tubes disrupted so high chance of “miswiring” during regeneration.

Question 4

What is Tinel’s sign?

Answer 4

Tapping directly over the nerve so can monitor the regrowth. Will get shooting pains when reach the end of the nerve.

Question 5

What nerve is commonly used in nerve grafts?

Answer 5

Sural nerve as it only causes slight numbness over the lower leg

Question 6

What is the rule of three in a peripheral nerve surgery?

Answer 6

Immediate surgery within 3 days for clean and sharp injuries
Early surgery within 3 weeks for blunt/contusion injuries
Delayed surgery, performed 3 months after injury, for closed injuries.

Question 7

What is traction apophysitis (Osgood Schlatter’s disease)?

Answer 7

Insertion of patellar tendon into anterior tibial tuberosity especially in adolescent active boys with a recurrent load leading to inflammation. No treatment required.

Question 8

What is avulsion?

Answer 8

Failure at insertion

Load exceeding failure strength while muscle contracting

Question 9

What is the treatment for avulsion?

Answer 9

Conservative
Limited application
Retraction tendon
Operative
Reattachment tendon
Through bone
Fixation bone fragment

Question 10

What are two kinds of tears that can happen at the tendon and ligament?

Answer 10

Intrasubstance tear-tears at the tendon

Musculotendinous JunctionTear-tear at the medial head

Question 11

What is the management of a rupture?

Answer 11

Conservative
Where ends can be opposed
Mobilise (partial rupture) e.g. med lig knee
Splint/cast
Where healing will occur 
Not intraarticular

Operative
High risk re-rupture
High Activity
Ends cannot be opposed