The Peripheral Nervous System Consists of:

The Peripheral Nervous System or PNS is the nervous system outside of the brain and spinal cord that doesn’t control the organs or glands in the body, as that is a different part of the nervous system. This includes the muscles used for movements, especially the ones in the limbs.
About Peripheral Nervous System Nerves

Nerves are not highly vascularised. This means that they don’t have a large blood supply going to them. Because of this, nerves take a long time to be able to heal, if they can heal at all. However, there have been people who have had amputations done to their leg, and feel as though they can still feel their foot. These are called phantom limbs or pain and is because some part of the nerve has healed and coils at the bottom of the amputation, sending a signal to the brain as though the limb is still there when it isn’t.

Parts of Peripheral Nervous System

There are 2 parts to the PNS, there is sensory input, which brings information back to the brain, and motor output, which sends signals from the brain to the body. The actions that the PNS are responsible for are muscular movements of the body, as well as our sense of touch, including temperature, or knowing if something is smooth or rough, soft or hard, light or deep pressure.

Injuries to the Peripheral Nervous System

When the PNS is injured there can be several varying degrees of the injury. This is because the location of the nerve injury is a big factor. The closer it is to the spinal cord, the more side effects that will be noticed. It will also change depending on the severity of the injury. This includes a lesion (scar tissue build-up after an injury to the nerve), compression (can happen from muscular imbalances, dislocations or fractures. Can also happen with birth defects, such as being born with an extra rib), or a partial to complete severance of the nerve (car accidents or work accidents, where a limb is cut, or amputated). Or as a secondary effect from a preexisting condition

Not all nerve damage affects the entire nerve, but only one portion of it. This happens a lot with a compression injury, where either the sensory or motor aspect of the nerve is affected. When it is the sensory aspect that is affected, it can show many different symptoms. This can be that the person may not be able to tell the difference in extreme temperatures, but may know that when they touch something that it’s soft or hard. You can also have a tingling or burning feeling in the limb to having a complete numbing feel if the sensory part of the nerve is completely compressed. As for the motor aspect of the nerve, if it is compressed, it can range from muscle weakness to complete paralysis.

Nerve Injuries:

Depending on the nerve that is compressed, or damaged, will determine the area of the body that’s affected. 5 main nerves can be compressed. Though there are others, these are the main ones.
Radial nerve: C5-T1 and stops at the wrist. If it’s affected it will cause Drop wrist which causes the hand to hang down (this nerve innervates the extensors of the wrist along with triceps so the back of the arm may also be numb). This can be compressed at the underarm, dislocation at the elbow, supinator muscle near the elbow, but it is more common to have the compression in the lower part of the arm compared to the upper arm.

Ulnar Nerve: C8-T1 to the little finger and half of the ring finger. If affected it will cause claw hand this is because there is some loss of finger flexion (this nerve innervates the medial flexors of the hand, mainly the hypothenar (side of the little finger) muscles). The common compression sites are at the upper arm, elbow, and wrist

Median Nerve: C5-T1 and goes to the first three fingers (thumb, index, and middle finger) and half of the ring finger. It innervates the wrist flexors and thumb. Some of these muscles can be innervated to some extent by the ulnar nerve. The most common areas for the median nerve to be pinched is at the elbow and the wrist. This is also the nerve that is affected in the Carpal Tunnel but is generally only affecting the sensory portion of the nerve. When paralysis is present, this is also known as ape hand (the thumb is forced into extension), or oath hand when the person tries to make a fist as the little finger and part of the ring finger are the only ones able to fully flex.

Sciatic nerve: This is a very large nerve and greatly changes in appearance depending on the area where the nerve is affected. It leaves the spine at L4-S1 but has 2 different divisions, the tibial and peroneal. It travels down through the gluteal area, staying in the back of the upper leg till it gets to the knee and splits, where half stays in the back of the leg, the other half going to the front of the leg. Both then travel down to the toes, one staying on the sole, and the other staying on the top of the foot. Complete compression of the sciatic nerve, is seen as foot drop as the foot hangs down. If the tibial portion of the sciatic nerve is compressed, it is called claw toe, where it forces the toes into extension. There can also be compressions into the nerve much higher in the nerve which is referred to as Sciatica or Piriformis syndrome depending on the reason for the compression. This doesn’t give a particular appearance compared to the other compression sites in the nerve, rather causes pain/numbing and muscle weakness in the leg and foot.

Bell’s Palsy: This is a paralysis of the face that is from the trigeminal nerve being compressed. This nerve comes out from the brain stem and controls the muscles of the face. This condition is still not understood very well but can be caused by swelling, trauma, Parotid gland conditions, exposure to drafts, or chills. This condition can have a very fast onset, from no symptoms one night to waking up the next morning with full symptoms. This condition only affects one side of the face. On the affected side the person won’t be able to close the eye and can have distorted fascial expressions including flaring the nose, purse the lips, etc… It can also cause the person affected with this type of condition, to have difficulty in speaking, as the lips may be difficult to move.

Treating Peripheral Nervous System Injuries

Treatment for most of these nerves is done through the same process when using Massage Therapy, except for Sciatica. Please click on here for more info. Though there is no guarantee that after treatment of the nerve, that full function-ability will come back to the affected area. It will depend on the severity of the damage to the nerve, how long it’s been damaged for, what caused the damage (especially if it is because of repetitive movements done at work, which are continued even after treatment), and your health.
The position will depend on what nerve is affected. Both comfort and pillowing to be in a neutral position will try to be achieved, as long as it doesn’t induce pain and spasms. Once optimal positioning is achieved, the treatment will depend on how much pain is being experienced. If there is a lot of pain present, the massage will be done as a relaxation massage to help with decreasing the pain. Hydrotherapy can be used, including heat, if there is no swelling present, or cool if swelling is present. Once pain is manageable the massage will change to a more treatment-oriented session. This starts with the unaffected muscles being treated first. That is because the unaffected muscles will be tight, and until they are relaxed and stretched, the affected muscles will not be able to have a chance to contract, as the opposing force will be too strong.
Once the unaffected muscles are relaxed, the affected muscle has stimulating techniques performed on them. This helps to activate the nerve and encourage the nerve to start firing again. These techniques include non-rhythmical, fast-paced techniques, and the use of cool to cold applications. If nerve damage is caused by compression from the muscles, then the muscles will be also treated. If there is severe discomfort (a level of 7 or more on a pain scale from 1-10), the muscle may be only treated on its attachment sites, rather than directly on the muscle belly (the bulk of the muscle). This is to help relax the muscle so it stops putting as much pressure on the nerve, causing pain, which then trigger points can be treated. However, if the nerve is being compressed from scar tissue, due to surgery or fracture in the nearby bone, more fascial work will be done to break apart the scar tissue.
In later treatments, if progression is seen, the range of motion will be introduced. First, it is done passively. This helps with body awareness and getting back the feeling of how to do the movement. Then it will progress to active range of motion, then to resisted range of motion. This is done slowly and will take time to do. Some clients do feel frustrated in doing active range of motion, as it can be a slow process for the nerve to heal and have the signal get to the end of the nerve. Breathing techniques are encouraged, as stress and frustration can make it more difficult to do active motions during the healing process.

Note:

When treating Bell’s Palsy, both the eye and mouth are included in the treatment. When either of these areas are being worked on, the therapist must wear gloves. If both areas are being worked on in the same treatment, the therapist will have to change their gloves, especially when moving from the mouth to the eye. This is to protect the eye from infection and to keep bodily fluids from being transferred from the client to the therapist, or debris (such as oil or lotion) from the therapist’s hand into the eyes or mouth.