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Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Nikhil Agrawal, Chaitanya Mudgal
The most common causes of ulnar nerve palsy encountered by the hand surgeon are from trauma and from compression neuropathy. Understanding the anatomy of the ulnar nerve will guide your physical examination. Begin by observing and palpating the patient's extremity. Then move onto checking sensation and performing physical examination manoeuvres. Utilizing a thorough physical examination, the diagnosis can the distinguished from spinal cord pathology or mixed nerve injuries. In addition, the difference between and high and low ulnar nerve palsy can be elucidated.
Spinal Injuries
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The spinal cord is divided into 31 segments each with a pair of anterior (motor) and dorsal (sensory) spinal nerve roots. On each side, the anterior and dorsal nerve roots combine to form the spinal nerves as they exit from the vertebral column. Each segmental nerve root supplies motor innervation to specific muscle groups (myotomes) and sensory innervation to a specific area of skin (dermatome). By testing sensory modalities and motor functions, it is possible to localize any neurological abnormality to specific spinal levels. The neurological level of injury is the lowest (most caudal) segmental level with normal sensory and motor function. A patient with a C5 level exhibits, by definition, abnormal motor and sensory function from C6 down. It is important to remember that the spinal cord segments do not correspond to the vertebral levels.
Functional Neurology
Published in James Crossley, Functional Exercise and Rehabilitation, 2021
The spinal cord is a tubular bundle of nerve tissue, approximately 40 to 50 cm long, that extends from the base of the brain down the vertebral column. The spinal cord acts like an information highway, connecting the brain to the peripheral tissues via spinal nerves. Messages travel from the brain, down the spinal cord and reach the muscles via motor nerves. At the same time, sensory information is sent from the periphery, up the spinal cord back to the brain.
Extramedullary haematopoiesis in patients with transfusion dependent β-thalassaemia (TDT): a systematic review
Published in Annals of Medicine, 2022
Eihab A. Subahi, Fateen Ata, Hassan Choudry, Phool Iqbal, Mousa A. AlHiyari, Ashraf T. Soliman, Vincenzo De Sanctis, Mohamed A. Yassin
Presenting features were not specified in a majority (N = 184, 72%) of cases (including the two retrospective studies) [14,15]. In the remaining patients, the authors reported a spectrum of presentation features. Thirty-two patients presented with clinical features of spinal cord compression. We found a small number of patients with symptoms of compression compared to the total number of patients with EMH around the spine. This is mainly because, in the two retrospective studies, which had 182 patients, the patients did not have any symptoms of EMH [14,15]. Lower limb weakness was reported in 23 (9.0%) patients. Nineteen (7.5%) patients presented with local pain at the site of EMH, whereas 3 (1.18%) presented with urinary incontinence. Ten patients (4%) presented with the finding of mass, either visible or incidental, on examination or imaging (Figure 2).
Perforin affects regeneration in a mouse spinal cord injury model
Published in International Journal of Neuroscience, 2021
Igor Jakovcevski, Melitta Schachner
Cell counts were performed on an Axioscope microscope (Zeiss) equipped with a motorized stage and Neurolucida software-controlled computer system (MicroBrightField) using the optical disector method, as described [35,42]. Coronal spinal cord sections from the 1.5-mm-long segment starting at the caudal side of the lumbar enlargement, thus comprising almost the complete lumbar spinal cord, were used for counting. The sections were examined under low-power magnification (10x objective) with a 365/420 nm excitation/emission filter set (01, Zeiss, blue fluorescence). The nuclear staining allowed the delineation of spinal cord gray and white matter areas. Numerical density of Iba-1+ and GFAP + cells was estimated by counting nuclei of immunolabeled cells within systematically spaced optical disectors. The parameters for this analysis were: guard space depth 2 μm, base and height of the disector 3600 μm2 and 10 μm, respectively, distance between the optical disectors 60 μm, using the Plan-Neofluar 40/0.75 objective. Left and right spinal cord areas were evaluated in six sections 250 µm apart each. All results shown are averaged bilateral values.
Regenerative replacement of neural cells for treatment of spinal cord injury
Published in Expert Opinion on Biological Therapy, 2021
William Brett McIntyre, Katarzyna Pieczonka, Mohamad Khazaei, Michael G. Fehlings
Another common line of treatment following spinal cord injury involves physical rehabilitation, which has been associated with functional improvements. Fundamentally, physical activity is able to mitigate cellular pathophysiology, which makes it a promising conjunctive therapy. At the level of the neuron, exercise is associated with a decrease in neuronal apoptosis [32] and a reduction in motor neuron dendritic atrophy, thus indicating that it is beneficial for maintaining synaptic integrity [33]. Interestingly, exercise induces upregulation of the expression of proteins and trophic factors that are involved in the survival of motor neurons and sensory neurons. As such, exercise may have ranging implications for different types of neurons [33]. In the context of oligodendrocytes, physical activity may reduce demyelination and/or improve remyelination, as it is associated with an increased number of myelinated axons in a model of peripheral nerve damage [34]. Finally, exercise is associated with a decrease in phagocytic and reactive glia, which may restrict glial scar formation [32].