Neurological Conditions By Nady Saleh ElSaid Orthopedic Neurological
Neurological Conditions By Nady Saleh El-Said
Orthopedic Neurological conditions • Peripheral nerve injuries • Poliomyelitis • Cerebral palsy • Some neurological disorders
CNS pathology Loss of inhibition of LMN (UMN) Loss of connection to LMN(LMN) -spasticity -hyper reflexia -clonus -co-contraction -flacidity -hypo reflexia -wasting of muscle -sensory deficits *weakness *poor balance *muscle shortening *joint instability *bony deformity &torsion
1 -lower motor neuron lesions (LMN) • Poliomyelitis • Peripheral nerve injuries • Spina bifida • Guilain Barre syndrome • Peroneal muscular atrophy
poliomyelitis • Virus infection • Acute stage • Convalescent stage • Chronic stage from two years onwards
Poliomyelitis • Chronic stage: residual paralysis and deformities • Grading of muscle power: zero-to grade 5
poliomyelitis • Differential diagnosis: Peripheral nerve injuries. Myopathies.
poliomyelitis • Operative treatment indicated for: • A-correction of deformity. • B-stabilisation of joints. • C-restoration of motor function
A-Correction of deformities • Conservative: passive stretching or wedge plaster. • Operative correction: soft tissue release, osteotomy, or wedge resection of joints or corrective arthrodesis.
B-Stabilisation of joints • Limitation of movement of the joint by bone block or arthrodesis. • Tendon transfer. The requirements for successful tendon transfer.
2. Upper motor neuron lesions (UMN) • Cerebral palsy (c p). Why ! • Definition of c p Non progressive UMN lesion in immature patients.
cp • Etiology : perinatal. -Prenatal, or post natal. • Classifications: -Topographical. hemiplegia, diplegia, quadriplegia, double hemiplegia, -Neurological. Spastic, dyskinesia, mixed.
Cp • Surgical treatment may be useful in c p : a - To correct deformity, whether static or dynamic, or both. B- To balance muscle power. or C- To stabilize uncontrollable joints.
Hips and knees flexion with equinus feet.
Genu recurvatum and equinus foot.
Equinus foot and muscle wasting.
Tendo Achilus lengthening (Z -PLASTY)
Gastrocnemius recision
Equinovarus foot
Arthrodesis of subtalar joint
Subtalar corrective arthrodesis
Femoral osteotomy
Adductor contraction
Flexion elbow and wrist with forarm pronation.
Neurological conditions
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