{"id":5773,"date":"2025-06-13T10:18:58","date_gmt":"2025-06-13T08:18:58","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=5773"},"modified":"2025-10-16T14:12:03","modified_gmt":"2025-10-16T12:12:03","slug":"neuropathies-peripheriques","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=5773","title":{"rendered":"Neuropathies p\u00e9riph\u00e9riques"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Introduction<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Aspects cliniques g\u00e9n\u00e9raux en cas de l\u00e9sion du SNP<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Diminution\/abolition des r\u00e9flexes ost\u00e9otendineux<\/li>\n\n\n\n<li>Fasciculations : contractions musculaires br\u00e8ves visibles \u00e0 l\u2019oeil nu n d\u00e9pla\u00e7ant pas le membre<\/li>\n\n\n\n<li>D\u00e9ficit moteur<\/li>\n\n\n\n<li>Amyotrophie (signe majeur) usuellement absent au d\u00e9but<\/li>\n\n\n\n<li>R\u00e9traction tendineuse<\/li>\n\n\n\n<li>D\u00e9ficit sensitif : superficiel, thermo-algique, ataxie proprioceptive (le patient regarde vers le bas pour voir ses MI)<\/li>\n\n\n\n<li>Troubles v\u00e9g\u00e9tatifs : hypotension orthostatique, troubles vasomoteurs, anomalies de la peau<\/li>\n\n\n\n<li>Pas de signes en faveur d\u2019une atteinte du SNC (sauf l\u00e9sion associ\u00e9e)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Examens compl\u00e9mentaires usuels<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Electromyogramme\u00a0<\/strong>: permet de diff\u00e9rencier les atteintes axonales (diminution des amplitudes des PA, activit\u00e9 spontan\u00e9e au repos) d\u2019une atteintes d\u00e9my\u00e9linisantes (diminution des vitesses de conduction, allongement des temps de latences distales motrices)<\/li>\n\n\n\n<li><strong>Biologie\u00a0<\/strong>: cause m\u00e9tabolique, diab\u00e8te<\/li>\n\n\n\n<li><strong>Imagerie\u00a0<\/strong>: recherche de compression nerveuse\/radiculaire<\/li>\n<\/ul>\n\n\n\n<p>Arbre d\u00e9cisionnel pour le diagnostic des neuropathies p\u00e9riph\u00e9riques<\/p>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/Atteinte-du-SNP-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"1014\" height=\"800\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/Atteinte-du-SNP-png.avif\" alt=\"\" class=\"wp-image-3821\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/Atteinte-du-SNP-png.avif 1014w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/Atteinte-du-SNP-300x237.avif 300w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/Atteinte-du-SNP-768x606.avif 768w\" sizes=\"auto, (max-width: 1014px) 100vw, 1014px\" \/><\/a><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Les syndromes canalaires (mononeuropathie)<\/h2>\n\n\n\n<p>D\u00e9finition : compression m\u00e9canique des nerfs p\u00e9riph\u00e9riques<br>Mononeuropathie : atteinte d\u2019un tronc sp\u00e9cifique<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome du canal carpien : compression du nerf m\u00e9dian<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Paresth\u00e9sie et hypoesth\u00e9sie des 3 premiers doigts<\/li>\n\n\n\n<li>Signes de\u00a0<a href=\"https:\/\/image.jimcdn.com\/app\/cms\/image\/transf\/dimension=241x10000:format=png\/path\/sace9003747f9a360\/image\/i242de3039a063889\/version\/1728397416\/canal-carpien-test-de-tinel-syndrome-du-canal-carpien.png\">Tinel\u00a0<\/a>et\u00a0<a href=\"data:image\/jpeg;base64,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\">Phalen\u00a0<\/a>peuvent \u00eatre positifs<\/li>\n\n\n\n<li>Parfois secondaire \u00e0 la grossesse, hypothyro\u00efdie, diab\u00e8te<\/li>\n\n\n\n<li>Traitement : orth\u00e8se de repos, injection de cortico\u00efde, chirurgie<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome du nerf ulnaire au coude<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Compression du nerf ulnaire dans la goutti\u00e8re \u00e9pitrochl\u00e9o-ol\u00e9cranienne : mouvements r\u00e9p\u00e9t\u00e9s de F\u00b0\/Ext\u00b0 de coude, appui statique prolong\u00e9, s\u00e9jour en r\u00e9animation<\/li>\n<\/ul>\n\n\n\n<p><strong>Clinique<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Paresth\u00e9sies du V + face m\u00e9diale du IV<\/li>\n\n\n\n<li><a href=\"https:\/\/www.guideline.care\/formations-medias\/30\/signe-de-froment.jpg\">Signe de Froment<\/a>\u00a0positif<\/li>\n\n\n\n<li>Faiblesse des interosseux :\u00a0<a href=\"https:\/\/www.membre-superieur.com\/assets\/static\/main-ulnaire.887e3f5.40bb4ee8cab21751c69fd22e40ebda53.png\">signe du croisement<\/a>\u00a0(impossibilit\u00e9 de superposer m\u00e9dius sur index)<\/li>\n\n\n\n<li>Amyotrophie \u00e9minence hypoth\u00e9nar<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-5-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"626\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-5-png.avif\" alt=\"\" class=\"wp-image-3826\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-5-png.avif 1024w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-5-300x183.avif 300w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-5-768x470.avif 768w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/a><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome du canal de Guyon<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Compression du nerf ulnaire<\/li>\n\n\n\n<li>Paresth\u00e9sie des 2 derniers doigts<\/li>\n\n\n\n<li>Amyotrophie hypoth\u00e9nar, interosseux, adducteur du pouce<\/li>\n\n\n\n<li>Beaucoup plus rare que syndrome du canal carpien<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-6-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"202\" height=\"250\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-6-png.avif\" alt=\"\" class=\"wp-image-3829\"\/><\/a><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome du nerf interosseux post\u00e9rieur<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Compression du nerf radial<\/li>\n\n\n\n<li>Mouvements de pronosupination r\u00e9p\u00e9t\u00e9s, violonistes<\/li>\n\n\n\n<li>Extension de poignet pr\u00e9serv\u00e9 mais d\u00e9ficit des extenseurs des doigts<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-7-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"405\" height=\"481\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-7-png.avif\" alt=\"\" class=\"wp-image-3832\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-7-png.avif 405w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-7-253x300.avif 253w\" sizes=\"auto, (max-width: 405px) 100vw, 405px\" \/><\/a><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Compression du nerf fibulaire commun<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Au niveau du col de la fibula le plus souvent<\/li>\n\n\n\n<li>Travailleurs du b\u00e2timent, agriculteur (travail au sol\/\u00e0 genou), patients en r\u00e9animmation (amyotrophie, compression sur barri\u00e8re de lit)<\/li>\n\n\n\n<li>D\u00e9ficit des releveurs du pied<\/li>\n\n\n\n<li>Amyotrophie de la loge ant\u00e9ro externe de la jambe<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Les syndromes radiculaires<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Compression des racines nerveuses lors de leur sortie de la moelle \u00e9pini\u00e8re, avant le foramen intervert\u00e9bral<\/li>\n\n\n\n<li>Souvent sur pathologies ost\u00e9o-articulaires d\u00e9g\u00e9n\u00e9ratives (herbie discale, arthrose) mais aussi pathologies infectieuses et tumorales<\/li>\n\n\n\n<li>Attention aux souffrances m\u00e9dullaires associ\u00e9es (\u00e9l\u00e9ments centraux surajout\u00e9s)<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Racine<\/td><td>D\u00e9ficit sensitif<\/td><td>D\u00e9ficit moteur<\/td><\/tr><tr><td>C5<\/td><td>Moignon de l\u2019\u00e9paule<\/td><td>Delto\u00efde<\/td><\/tr><tr><td>C6<\/td><td>Face ant\u00e9rieure du bras<br>Face lat\u00e9rale de l\u2019avant bras<br>Doigt : pouce +++<\/td><td>Biceps brachial + brachial ant\u00e9rieur<\/td><\/tr><tr><td>C7<\/td><td>Face post\u00e9rieure de l\u2019avant-bras<br>Doigt : majeur +++<\/td><td>Triceps brachial<\/td><\/tr><tr><td>C8<\/td><td>Face m\u00e9diale du bras et avant\u00e8bras<br>Doigt : 5e +++<\/td><td>Fl\u00e9chisseurs des doigts + interosseux<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Racine<\/td><td>D\u00e9ficit sensitif<\/td><td>D\u00e9ficit moteur<\/td><\/tr><tr><td>L3-L4<\/td><td>Fesse<br>Face ant\u00e9ro-lat\u00e9rale de la cuisse<br>Face ant\u00e9ro-m\u00e9diale du genou et de la jambe<\/td><td>Quadriceps +++<br>Tibial ant\u00e9rieur +<\/td><\/tr><tr><td>L5<\/td><td>Fesse<br>Face post de la cuisse<br>Face lat\u00e9rale de la jambe<br>Face dorsale du pied<\/td><td>Extenseur des orteil<br>Tibial ant\u00e9rieur<br>Fibulaires<\/td><\/tr><tr><td>S1<\/td><td>Fesse<br>Face post\u00e9rieure de la cuisse et de la jambe<br>Face plantaire du pied<\/td><td>Triceps sural +++<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome de la queue de cheval<\/h3>\n\n\n\n<p><strong>Clinique<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Troubles sensitifs : hypo ou anesth\u00e9sie avec topographie variable, anesth\u00e9sie en selle caract\u00e9ristique (p\u00e9rin\u00e9e, OGE, marge anale)<\/li>\n\n\n\n<li>Troubles moteurs : troubles de la marche ou parapl\u00e9gie compl\u00e8te, souvent d\u00e9ficit moteur asym\u00e9trique<\/li>\n\n\n\n<li>Abolition des ROTS et des r\u00e9flexes p\u00e9rin\u00e9aux<\/li>\n\n\n\n<li>Troubles v\u00e9sico-sphinct\u00e9riens : r\u00e9tention aigu\u00eb d\u2019urine, urgenturie, constipation<\/li>\n<\/ul>\n\n\n\n<p>Etiologies<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hernie discale +++<\/li>\n\n\n\n<li>Tumeurs : \u00e9pendymomes ++<\/li>\n\n\n\n<li>Spondylodiscite : infection du disque vert\u00e9bral<\/li>\n\n\n\n<li>Canal lombaire r\u00e9tr\u00e9ci<\/li>\n<\/ul>\n\n\n\n<p><strong>=&gt; Urgence neurochirurgicale +++<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Polyradiculon\u00e9vrite<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome de Guillain Barr\u00e9<\/h3>\n\n\n\n<p>Atteinte de la racine et du nerf<\/p>\n\n\n\n<p>Contexte post infectieux fr\u00e9quent<br><strong>2 grandes formes<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Atteinte d\u00e9my\u00e9linisante<\/li>\n\n\n\n<li>Atteinte motrice pure (AMAN)<\/li>\n<\/ul>\n\n\n\n<p><strong>Physiopathologie<\/strong><\/p>\n\n\n\n<p>Pathologie auto-immune complexe<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"352\" height=\"254\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-8-png.avif\" alt=\"\" class=\"wp-image-3841\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-8-png.avif 352w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-8-300x216.avif 300w\" sizes=\"auto, (max-width: 352px) 100vw, 352px\" \/><\/figure>\n\n\n\n<p>Clinique<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9ficit sensitivomoteur ascendant avec ar\u00e9flexie ost\u00e9o-tendineuse<\/li>\n<\/ul>\n\n\n\n<p>Evolution en 3 phases<\/p>\n\n\n\n<p><strong>1 \u2013 Phase d\u2019extension<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Dur\u00e9e variable : de quelques jours \u00e0 quelques semaines<\/li>\n\n\n\n<li>D\u00e9but par ph\u00e9nom\u00e8ne sensitifs (paresth\u00e9sie, picotements distaux) puis progressivement ascendants<\/li>\n\n\n\n<li>Sym\u00e9trie des sympt\u00f4mes<\/li>\n\n\n\n<li>Paralysie distale qui touche les membres d\u2019abord en proximal<\/li>\n\n\n\n<li>Parfois atteinte des muscles respi, d\u00e9glutition -> r\u00e9animation<\/li>\n<\/ul>\n\n\n\n<p>=&gt; Plus la phase d\u2019extension est rapide, moins bon est le pronostic pour les formes d\u00e9my\u00e9linisantes<\/p>\n\n\n\n<p><strong>2 \u2013 Phase de plateau<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9ficit moteur d\u2019intensit\u00e9 et de dur\u00e9e variable<\/li>\n\n\n\n<li>Ar\u00e9flexie tendineuse<\/li>\n\n\n\n<li>Syndrome dysautonomique (tachycardie, bradycardie)<\/li>\n<\/ul>\n\n\n\n<p><strong>3 \u2013 Phase de r\u00e9cup\u00e9ration<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>En ordre inverse de l\u2019apparition des d\u00e9ficits<\/li>\n\n\n\n<li>En cas d\u2019absence de r\u00e9cup\u00e9ration \u00e0 12-18 mois : \u00e9tat d\u00e9finitif<\/li>\n\n\n\n<li>5% de d\u00e9c\u00e8s, 15% de s\u00e9quelles d\u00e9finitives<\/li>\n<\/ul>\n\n\n\n<p><strong>Complications \u00e0 long terme<\/strong>&nbsp;: douleurs neuropathiques, d\u00e9ficits persistants, troubles proprioceptifs, r\u00e9tractions<\/p>\n\n\n\n<p><strong>Examens compl\u00e9mentaires<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Clinique : histoire de la maladie<\/li>\n\n\n\n<li>Ponction lombaire<\/li>\n\n\n\n<li>Electromyogramme : ralentissement vitesse de conduction, blocs de conduction, augmentation des latences distales<\/li>\n\n\n\n<li>Biologie<\/li>\n<\/ul>\n\n\n\n<p><strong>Traitement<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Le plus rapidement possible<\/li>\n\n\n\n<li>But : stopper la r\u00e9action inflammatoire<\/li>\n\n\n\n<li>Points de vigilances en s\u00e9ance de r\u00e9\u00e9ducation : toujours bien \u00e9valuer la proprioception (ataxie, risque de chute), la motivation (r\u00e9cup\u00e9ration parfois tr\u00e8s longue)<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Polyneuropathies<\/h2>\n\n\n\n<p>Atteinte de toutes les fibres nerveuses en fonction de leur longueur (atteinte longueur-d\u00e9pendante)<br>Attaque les fibres les plus longues en premier<br>Atteinte de plusieurs fibres en m\u00eame temps, mais pas les racines<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"443\" height=\"328\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-9-png.avif\" alt=\"\" class=\"wp-image-3849\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-9-png.avif 443w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-9-300x222.avif 300w\" sizes=\"auto, (max-width: 443px) 100vw, 443px\" \/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Polyneuropathie diab\u00e9tique<\/h3>\n\n\n\n<p>Le diab\u00e8te est responsable de nombreuses complications dans l\u2019organisme, on parle d\u2019organes cibles : coeur, cerveau, oeil, rein, pied, nerf, infections<\/p>\n\n\n\n<p>Poolyneuropathie axonale longueur d\u00e9pendante : atteinte diffuse et sym\u00e9triques qui touche les extr\u00e9mit\u00e9s distales des fibres nerveuses les plus longues (donc les membres inf\u00e9rieurs)<\/p>\n\n\n\n<p><strong>M\u00e9canisme<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Isch\u00e9mique : alt\u00e9ration de la paroi des art\u00e8res de petits calibres qui vont vasculariser les nerfs<\/li>\n\n\n\n<li>Toxicit\u00e9 directe de l\u2019hypoglyc\u00e9mie (stress oxydatif)<\/li>\n<\/ul>\n\n\n\n<p><strong>Clinique<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Atteinte distale d\u2019\u00e9volution ascendante, sym\u00e9trique, \u00e0 pr\u00e9dominance sensitive+++<\/li>\n\n\n\n<li>Atteinte des petites fibres : paresth\u00e9sie, alt\u00e9ration de la sensibilit\u00e9 thermo algique (mal perforant plantaire)<\/li>\n\n\n\n<li>Atteinte dysautonomique (trouble v\u00e9sico-sphinct\u00e9rien, trouble du transit, impuissance)<\/li>\n<\/ul>\n\n\n\n<p><strong>El\u00e9ments de vigilance sur le plateau technique<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Risque d\u2019hypoglyc\u00e9mie (signe de tachycardie, sensation de faim brutale, frisson, tremblements, trouble de la coordination, de la concentration, etc)<\/li>\n\n\n\n<li>Attention aux troubles podologiques et si plaies<\/li>\n\n\n\n<li>Troubles visuels, facteurs de risque cardiovasculaire associ\u00e9s<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Polyneuropathie alcoolique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Toxicit\u00e9 de l\u2019alcool sur les fibres nerveuses ou par carence vitaminiques associ\u00e9es (B1 B9)<\/li>\n\n\n\n<li>Hypoesth\u00e9sie en chaussette<\/li>\n\n\n\n<li>Crampe nocture, fatigabilit\u00e9 \u00e0 la marche<\/li>\n\n\n\n<li>D\u00e9ficit moteur, amyotrophie distale<\/li>\n\n\n\n<li>Troubles cutan\u00e9s et trophiques (d\u00e9pilation anhydrose, ongles cassants)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Neuromyopathie de r\u00e9animation<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Faiblesse acquise en r\u00e9animation<\/li>\n\n\n\n<li>Syndrome qui recouvre polyneuropathie et la myopathie<\/li>\n\n\n\n<li>Touche les muscles p\u00e9riph\u00e9riques et les muscles respiratoires<\/li>\n\n\n\n<li>D\u00e9finition clinique : score MRC&lt;48 (sur 60)<\/li>\n<\/ul>\n\n\n\n<p><strong>Facteurs de risque<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>S\u00e9v\u00e9rit\u00e9 du tableau m\u00e9dical, sepsis s\u00e9v\u00e8re<\/li>\n\n\n\n<li>Hyperglyc\u00e9mie<\/li>\n\n\n\n<li>Immobilisation prolong\u00e9e<\/li>\n<\/ul>\n\n\n\n<p><strong>Physiopathologie complexe<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Dysfonction musculaire<\/li>\n\n\n\n<li>Alt\u00e9ration de la capacit\u00e9 de r\u00e9g\u00e9n\u00e9ration musculaire<\/li>\n<\/ul>\n\n\n\n<p><strong>Echelle pour s\u2019assurer de la bonne coop\u00e9ration du patient<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>RASS : niveau de conscience (+4=combatif; 0=\u00e9veill\u00e9 et calme; -3=diminution mod\u00e9r\u00e9e de la vigilance, -5= non r\u00e9veillable). Si RASS sup\u00e9rieur ou \u00e9gale \u00e0 3, proc\u00e9der au CAM-ICU<\/li>\n\n\n\n<li>CAM-ICU : 4 crit\u00e8res (fluctuation de l\u2019\u00e9tat mental, inattention, niveau de conscience alt\u00e9r\u00e9, pens\u00e9e d\u00e9sorganis\u00e9e)<\/li>\n<\/ul>\n\n\n\n<p><strong>Autres m\u00e9thodes<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Handgrip : &lt;11kg H ou &lt;7kg F<\/li>\n\n\n\n<li>Evaluation M respiratoire PIM &lt; 30cm d\u2019H2O<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Syndromes plexiques<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Surtout plexus brachial<\/li>\n\n\n\n<li>L\u00e9sions favoris\u00e9es chez les patients sous anesth\u00e9sie g\u00e9n\u00e9rale + curares<\/li>\n\n\n\n<li>Tableau complexe, en \u201cmosa\u00efque\u201d : d\u00e9ficit moteur et sensitif, abolition ROT<\/li>\n\n\n\n<li>Risque r\u00e9tractions myotendineuse<\/li>\n\n\n\n<li>R\u00e9cup\u00e9ration tr\u00e8s longue, parfois incertaine<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Introduction Aspects cliniques g\u00e9n\u00e9raux en cas de l\u00e9sion du SNP Examens compl\u00e9mentaires usuels Arbre d\u00e9cisionnel pour le diagnostic des neuropathies p\u00e9riph\u00e9riques Les syndromes canalaires (mononeuropathie) D\u00e9finition : compression m\u00e9canique des nerfs p\u00e9riph\u00e9riquesMononeuropathie : atteinte d\u2019un&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=5773\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0Neuropathies p\u00e9riph\u00e9riques\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[389],"tags":[],"class_list":["post-5773","post","type-post","status-publish","format-standard","hentry","category-champ-neuro-neuro-peripherique"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5773","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5773"}],"version-history":[{"count":1,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5773\/revisions"}],"predecessor-version":[{"id":5774,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5773\/revisions\/5774"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5773"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5773"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5773"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}