of the
Nerves
Assessment of nerve
Function
1
Bacterial invasion and
granuloma formation
Nerve thickening
Tenderness
Nerve Damage (Loss of function)
Neuritis Leprosy
2
Suspect nerve involvement
3
Suspect Nerve lesion
• Numbness or tingling of hands or feet
4
Suspect Nerve lesion
5
Presence of Disability or Deformity
Confirms involvement of the nerves
6
Examination of Nerves
Nerve
Palpation •Diagnosis
•Classification/grouping
Thickness •Assessment of risk of disability
Tenderness
•Grading of Disability
Consistency
•Follow-up
10
Skin condition - Hands & Feet
Blisters, dryness and wounds
11
Enlarged/ tender nerves
with / with out nerve function impairment
Ulnar
ULNAR
Greater
Auricular nerve
GREAT
AURICULAR
Dorsal
Cutaneous br
Supratrochlear of ulnar N
12
Sensory Cutaneous nerves-
13
Commonly affected nerve with motor function
Facial
Ulnar
Median
Radial
Lateral popliteal
Posterior tibial
14
Testing For Sensory Deficit
Hands / Feet
15
Sensory Testing – Hands & Feet
16
Recording results of sensory test
9 9 8 9
9 8
9 9
9 8
9 9
17
Ballpen test – wrong technique
18
Sensory supply of commonly affected nerves
19
Interpretation of test for loss of sensation:
20
Quick Muscle Test
• Face
Blinking of eyes Trigeminal nerve
Lid lag or lagophthalmos Facial Nerve
• Hand
Book test, fromet sign,
Card test Ulnar
Oschner’s clasping hand,
Pen test Median
wrist extension Radial nerve
• Foot
Stand on Toes Lateral popliteal nerve
Spreading of toes Posterior Tibial nerve
21
Quick Muscle Test
Beak Test
• Ulnar
• Median
• Radial Nerve
Standing on toes
Spreading of Toes
Posterior Tibial Nerve
Walk on heels
22
Common peroneal Nerve
Detailed Muscle Test – Muscle Strength
• Eye closure (facial nerve)
Blinking of eye Trigeminal nerve (sensory nerve)
Light closer of eyes Facial nerve
Tight closer of eyes Early weakness
24
Lagophthalmos
Grading of Muscle Strength
Make patient comfortable on stool
26
Grading of Muscle Strength
Ask to close eye tightly and try to pull the lower lid down and
see whether the patient is able to keep his eyes closed
against resistance
27
Grading of Muscle Strength of eyelid
28
Signs of facial nerve involvement
30
Median Nerve
31
Radial nerve
32
Lateral Popliteal Nerve
33
Posterior tibial Nerve
34
WHO Grading of Disability
Anaesthesia present
Grade 1 but no visible Not assigned
deformity or damage.
2. Steroids
3. Splinting
4. Monitoring
5. Supportive therapy
37
Damage of new nerve
38
Worsening of existing damage
39