Treatment for neurologic condition
CONDITION: Peripheral nerve injuries of the upper limb
Peripheral nerve injuries refer to injuries of median, ulnar and radial nerve in the arm,
forearm and hand. These result in loss of sensory and /or motor control in the distribution
of that particular nerve.
Causes of nerve injuries
Avulsion: nerve roots are torn from the spinal cord
Lacerations: cut to the nerve
Compression and traction: large part of the nerve will not recover
Crush injuries: e.g. fractures,
Three types of injuries that can occur:
1. Axonotmesis: resultant of a traction injury. The axon is damaged but the sheath is
intact. Complete motor and sensory loss.
2. Neuropraxia: resultant of pressure on the nerve. All structures of the nerve
remain intact. Complete motor loss and minimal sensory loss.
3. Neurotmesis: all the structures of the nerve have been damaged. Complete motor
and sensory loss. Recover possible only with repair and tendon transfer.
Symptoms
Impaired function and symptoms vary from person to person, depending on the nerve
affected and the level where the injury occurred (wrist, forearm, elbow, above elbow
and shoulder).
RADIAL NERVE
Forearm level
1. loss of wrist extension
2. sensation loss to dorsum of the arm and the wrist
3. loss of MCP extension
Elbow level
1. loss of supination
Above elbow
1. as above
2. weakened extension
Upper arm
1. as above
2. loss of elbow extension
3. loss of hand grip due to loss of wrist extension
ULNAR NERVE
At wrist level
1. loss of sensation on the ulnar side of the hand
2. claw hand deformity
3. loss of finger adduction and abduction
4. ↓ grip strenght ( power > precision)
5. difficult writing
At elbow / above elbow region
1. flattened hypothenar muscles
2. atrophy of interossei
3. same as above
MEDIAN NERVE
Functional loss
1. inability to form precision grasp due to loss of thenar intrinsic i.e. ↓ finertip
prehinsion
2. loss of power grip
3. incoordination due to sensation loss
4. unstable thumb
5. writing difficult due to loss of thumb and index finger flexion
6. ape’s hand deformity
TREATMENT
RADIAL NERVE
1. splinting to support wrist extension, correct wrist flexion, and for functional
positioning of the hand
2. assist with and ↑ grip strength by stabilizing the wrist
3. maintaining of ROM of fingers
4. retraining wrist and finger extensors
ULNAR NERVE
1. splinting to prevent clawing of the hand, help with hand grips
2. hand exercises retraining grip strength
MEDIAN NERVE
1. splinting to maintain web space
2. splinting to prevent deformities
3. hand exercises to ↑ power grip