[libribook.com] Traumatic Scar Tissue Management 1st Edition

Figure 4.8
Anterior and posterior divisions of the spinal cord and afferent/sensory and efferent/motor neurons.
Neurofascia
Fascia forms a tri-laminar, continuous structure that surrounds and invests
individual nerve fibers, bundles of fibers (fascicles) and the entire nerve, thus
constituting the three levels of organization (Fig. 4.9): 50% of peripheral nerves
consist of CT (Sunderland & Bradley 1949, Coppieters & Nee 2012).
Epineurium
• The outermost layer that surrounds the entire nerve comprises mostly areolar
tissue and houses the nerve’s blood and lymphatic vessels, which have feeder
vessels that branch off to supply all inner parts of the nerve.
• Epineural blood vessels are slightly coiled, rendering them adaptable of nerve
mobility within a ‘normal’ range. The loose areolar matrix allows for
unimpeded nerve fiber growth changes (Bove 2008, Magee 2008).
Perineurium
The perineurium:
• Is the intermediate layer that surrounds bundles or fascicles of nerve fibers.
Thin yet dense, it provides tensile strength and protects the nerve from over
extension trauma.
• Maintains the blood–nerve barrier and if cut into, the axon may herniate due to
traumatizing pressure changes (Bove 2008).
Endoneurium
The endoneurium is:
• The innermost layer that surrounds individual nerve fibers, offers little
mechanical support