SPLINTING FOR PERIPHERAL NERVE INJURY IN UPPER LIMB

The prognosis and speed of peripheral nerve recovery depend very much on the level of injury, severity of injury, the surgical intervention and the subsequent rehabilitative process. Many high level injuries may take years or months for the affected peripheral nerve to recover. Prolonged muscle imbalance causes joint contractures and over-stretching of denervated muscles. Without proper care, hand function recovery may be limited even the nerve regenerated afterwards. During the nerve regeneration period, splinting is one of the most useful modality to minimise deformities, prevent joint contractures and substitute loss motor control. Proper splinting encourages early use of the injured hand in daily activities. There are different types of splinting design for median nerve palsy, ulnar nerve palsy and radial nerve palsy. Dynamic splinting techniques are frequently employed to allow early prehension activities. Other therapeutic techniques, including pressure garment and sensory re-education are useful to enhance better functional return after nerve repair.

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Closed pinning for paediatric supracondylar fractures: does timing really matter?

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171461 ◽

2017 ◽

Vol 3 (3) ◽

pp. 417

Author(s):

Suresh Babu Surapaneni ◽

Ravi Kiran Kopuri ◽

Venkata Suresh Babu Tummala

Keyword(s):

Closed Reduction ◽

Nerve Palsy ◽

Radial Nerve Palsy ◽

Radial Pulse ◽

Supracondylar Fractures ◽

Average Delay ◽

Median Nerve Palsy ◽

Ulnar Nerve Palsy ◽

Pin Fixation ◽

Group 2

Background: Management guidelines and comparative studies are not yet clear for those patients who present early and late with widely displaced supracondyle humerus fracture in children.Methods: A total of 74 children were included in this study, 30 patients presenting early within 24 hours as group 1, and 44 patients who presented late i.e. after 24 hours and within a week as group 2 underwent closed reduction and pinning.Results: In group one 24 had excellent, 6 had good results, according to modified Flynn’s criteria. One patient developed ulnar nerve palsy which was iatrogenic, and improved completely after wire removal. Another was brachial artery injury which was explored and recovered completely. In group 2 the average delay in presentation was 57.56 hours; mean time to surgery after presentation was 9.83 hours. Sixteen patients (36.36%) had neurologic complications at presentation to the emergency room of which three had median nerve palsy (6.81%) whereas seven (15.90%) had isolated anterior interosseous nerve palsy and six (13.6%) had radial nerve palsy all patients showed total neurological recovery at 12 weeks. Six patients (13.63%) had vascular compromise at initial presentation of which five patients had feeble radial pulse and one had absent radial pulse, but capillary filling was adequate in all. The pulse was restored within 24 hours in all patients following reduction. There were 37 excellent, 6 good and 1fair results.Conclusions: Our results support, closed reduction and Percutaneous pin fixation as an effective treatment option for grossly displaced supracondylar fractures presenting early and late but requires good and careful judgment and also technique.

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Neurological

Oxford Handbook Clinical Tutor Study Cards: Medicine ◽

10.1093/med/9780198830849.003.0004 ◽

2019 ◽

pp. 109-186

Author(s):

Tanya M. Monaghan ◽

James D. Thomas

Keyword(s):

Nerve Palsy ◽

Cauda Equina ◽

Radial Nerve Palsy ◽

Pseudobulbar Palsy ◽

Subacute Combined Degeneration ◽

Charcot Marie Tooth Disease ◽

Tabes Dorsalis ◽

Median Nerve Palsy ◽

Ulnar Nerve Palsy ◽

Muscles Of The Hand

This chapter concerns neurological medicine, and covers dermatomes, peripheral nerves and tendon reflexes, peripheral neuropathy, hemiplegia, myotonic dystrophy, proximal myopathy, motor neurone disease, cerebellar syndrome, myasthenia gravis, cervical myelopathy, median nerve palsy, ulnar nerve palsy, radial nerve palsy, wasting of the small muscles of the hand, syringomyelia, polymyositis, Parkinson’s disease, Friedreich’s ataxia, Charcot–Marie–Tooth disease, subacute combined degeneration of the cord, tabes dorsalis, cerebellopontine angle syndrome, paraplegia, visual field defect, nerve palsy, nystagmus, Horner’s syndrome, ptosis, large pupil, small pupil, Holmes–Adie–Moore syndrome, Argyll Robertson pupil, internuclear ophthalmoplegia, facial palsy, bulbar palsy, pseudobulbar palsy, and cauda equina syndrome.

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The effects of sensory re-education on hand function recovery after peripheral nerve repair: A systematic review

Neurorehabilitation ◽

10.3233/nre-201612 ◽

2021 ◽

pp. 1-12

Author(s):

Weili Xia ◽

Zhongfei Bai ◽

Rongxia Dai ◽

Jiaqi Zhang ◽

Jiani Lu ◽

...

Keyword(s):

Systematic Review ◽

Peripheral Nerve ◽

Nerve Repair ◽

Hand Function ◽

Current Evidence ◽

Motor Deficits ◽

Peripheral Nerve Repair ◽

Hand Functions ◽

Function Recovery ◽

Short And Long Term

BACKGROUND: Peripheral nerve injury can result in both sensory and motor deficits, and these impairments can last for a long period after nerve repair. OBJECTIVE: To systematically review the effects of sensory re-education (SR) on facilitating hand function recovery after peripheral nerve repair. METHODS: This systematic review was limited to articles published from 1970 to 20 December 2020. Electronic searching was performed in CINAHL, Embase, PubMed, Web of Science, and Medline databases to include trials investigating the effects of SR training on hand function recovery after peripheral nerve repair and included only those studies with controlled comparisons. RESULTS: Sixteen articles were included in final data synthesis. We found that only four studies could be rated as having good quality and noted obvious methodological limitations in the remaining studies. The current evidence showed that early SR with mirror visual feedback and the combinational use of classic SR and topical temporary anesthetic seemed to have long- and short-term effects, respectively on improving the sensibility and reducing the disabilities of the hand. The evidence to support the effects of conventional classical SR on improving hand functions was not strong. CONCLUSIONS: Further well-designed trials are needed to evaluate the effects of different SR techniques on hand function after nerve repair over short- and long-term periods.

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Radial Nerve Palsy following Endovascular Embolization of an Arteriovenous Malformation

Journal of Wrist Surgery ◽

10.1055/s-0037-1607422 ◽

2017 ◽

Vol 07 (03) ◽

pp. 258-261

Author(s):

Ram Alluri ◽

Anuj Mahajan ◽

Alidad Ghiassi ◽

Venus Vakhshori

Keyword(s):

Peripheral Nerve ◽

Radial Nerve ◽

Nerve Palsy ◽

Case Reports ◽

Endovascular Embolization ◽

Careful Consideration ◽

Radial Nerve Palsy ◽

Direct Compression ◽

Endovascular Techniques

Background Arteriovenous malformations (AVMs) are commonly treated using endovascular techniques. Previous nerve palsies after embolization have been reported as isolated case reports, none of which affected the forearm. Case Description A case of acute, transient neuropathy of the radial nerve following embolization of a forearm AVM is described. The patient, an otherwise healthy 27-year-old man, began having symptoms of superficial radial nerve (SRN) and posterior interosseous nerve (PIN) palsies immediately following endovascular embolization. He underwent decompression of the radial nerve within 5 days and was found to have direct compression of the PIN and SRN. The patient recovered completely at the time of his 7-month follow-up. Literature Review Few cases of nerve palsy after endovascular embolization have been reported in the literature. Many are intracranial, but rare instances of peripheral nerve palsy have been reported, including two sciatic nerve and four digital nerve palsies after endovascular embolization. No cases of peripheral nerve palsy in the forearm have been reported. Clinical Relevance We recommend careful consideration of surrounding neural elements at risk for palsy prior to endovascular embolization and detailed discussion with the patient during the informed consent process.

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SUPRA CONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.03.698 ◽

2013 ◽

Vol 20 (03) ◽

pp. 456-461

Author(s):

MOGHEES IKRAM AMEEN ◽

AQEEL SAFDAR ◽

FAUZIA MOGHEES

Keyword(s):

Nerve Palsy ◽

Neurological Complications ◽

Late Presentation ◽

Radial Nerve Palsy ◽

X Rays ◽

Supracondylar Fractures ◽

Post Injury ◽

Type Iii ◽

Fractures In Children ◽

Median Nerve Palsy

Supra condylar fractures in children are a serious injury with a significant morbidity. Setting: CMH Multan. Patients presentvery late, often after being mishandled by traditional bone-setters, with lifelong consequences. All children up to the age of 12 years withsupra condylar humeral fractures presenting to our hospital were included in the study. Careful history and examination was carried outand necessary x-rays were taken. Time since injury, all treatments administered, complications and any other data was recorded. Period:From 1999 to 2004. 304 cases were included in the study. Only 12% patients presented within 24 hours. 87.5% children presented from72 hours to 3 weeks post injury. The reasons recorded were lack of access to proper medical help, illiteracy, poverty and manipulation bytraditional bone setters. Based on Gartland's Classification1 61% patients had un-displaced and 39% had displaced fractures. 61% wereType I fractures, 19% Type II and 20% Type III fractures. Due to late presentation these patients had more complications including myositisossificans, neurological complications and contractures due to tight bandages by traditional health bone setters. Patients with displacedsupracondylar fractures, who present early, usually require manipulation and fixation by percutaneous pinning 2,3,4. In our study,because of very late presentation they could not be treated by closed reduction and 18 %cases with type III fractures were treated by OpenReduction and Internal Fixation. Since they presented very late and had complications like Radial nerve palsy, Median nerve palsy, Ulnar5 nerve palsy , ischemia, Brachial artery compression, Compartment syndrome, Volkmann's ischemic contracture the treatment protocolhad to be changed. Post operative complications in a few patients included Pin tract infection and Elbow stiffness. In most cases full rangeof movement could not be achieved, however functional movement was satisfactory. These resulted in less patient satisfaction andlifelong consequences. To conclude our study shows that due to very late presentation of supracondylar fractures of the humerus inchildren different management protocols have to be made, tailored to individual needs of the patient.

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FLEXOR TENDON AND PERIPHERAL NERVE REPAIR

Hand Surgery ◽

10.1142/s021881040200087x ◽

2002 ◽

Vol 07 (01) ◽

pp. 83-100 ◽

Cited By ~ 11

Author(s):

Judith A. Bell Krotoski

Keyword(s):

Peripheral Nerve ◽

Nerve Injury ◽

Peripheral Nerve Injury ◽

Flexor Tendon ◽

Nerve Repair ◽

Hand Function ◽

Tendon Injury ◽

Finger Movement ◽

Flexor Tendon Injury ◽

Direct Injury

Any restoration of hand function following tendon and nerve injury has to include the repair or replacement of the hand's ability to perform a great many tasks. It is hard at first to appreciate fully the loss that occurs with flexor tendon injury. With loss of flexor tendons operating at the fingers or thumb, they cannot be fully closed and the hand is impaired for grasp and release as it interfaces with objects. But, sensibility can also be compromised from tendon injury even without direct injury to nerve, as object recognition in the absence of vision requires finger movement. When peripheral nerve injury is combined with flexor tendon injury, sensibility is directly impaired. There is a loss in the sense of finger or thumb position, pain, temperature, and touch/pressure recognition, in addition to the tendon injury.

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Reconstruction after nerve injury

10.1093/med/9780199550647.003.006009 ◽

2011 ◽

Author(s):

T.E.J. Hems

Keyword(s):

Nerve Injury ◽

Tendon Transfer ◽

Nerve Palsy ◽

Common Type ◽

Radial Nerve Palsy ◽

Reconstructive Procedures ◽

Tendon Transfers ◽

Ulnar Nerve Palsy ◽

Intrinsic Paralysis ◽

Median Nerve Injury

♦ Late reconstructive procedures may improve function if there is persisting paralysis after nerve injury♦ Transfer of a functioning musculotendinous unit to the tendon of the paralysed muscle is the most common type of procedure♦ Passive mobility must be maintained in affected joints before tendon transfer can be performed♦ The transferred muscle should be expendable, have normal power, and have properties appropriate to the function it is required to restore♦ Tendon transfers can provide reliable improvement in function after isolated radial nerve palsy♦ A number of procedures have been described for reconstruction of thumb opposition but impaired sensation after median nerve injury may limit gain in function♦ Tendon transfers are possible to improve clawing of fingers and lateral pinch of the thumb after ulnar nerve palsy or other cases of intrinsic paralysis.

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Results of Dynamic Claw Correction in Ulnar nerve Palsy

Bangladesh Journal of Plastic Surgery ◽

10.3329/bdjps.v3i1.15000 ◽

2013 ◽

Vol 3 (1) ◽

pp. 13-18

Author(s):

D Biswas ◽

MA Kalam ◽

A Roy ◽

FR Aolad

Keyword(s):

Plastic Surgery ◽

Ulnar Nerve ◽

Nerve Palsy ◽

Hand Function ◽

Lesion Group ◽

Common Procedure ◽

Ulnar Nerve Palsy ◽

Normal Hand ◽

Pip Joint ◽

Swan Neck Deformity

Normal hand function is a balance between the extrinsic-intrinsic and extensor-flexor group of musculature. Although individually the intrinsics are very small muscles, collectively they contribute about 50% of grip strength. Total 19 patents with claw deformity were corrected by 4 different techniques. 11 claws were due to high ulnar nerve palsy and 8 were due to low palsy. Result was excellent in 9 (47.36%), good in 7(36.84%), fair in 2(10.52%) and poor in 1(05.26%) patient. Zancollis Lasso was the most common procedure used for correction of claw deformity. 1(05.26%) patient developed swan neck deformity treated by FDS 4 tail procedure of low lesion group and final result was fair, another 1 (05.26%) patient developed contracture of the PIP joint. Though exact biomechanical correction of claw is complicated yet function of the hand can be improved with different techniques of tendon transfer.DOI: http://dx.doi.org/10.3329/bdjps.v3i1.15000 Bangladesh Journal of Plastic Surgery 2012, 3(1): 13-18

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Median to radial nerve transfer for treatment of radial nerve palsy

Journal of Neurosurgery ◽

10.3171/jns-07/09/0666 ◽

2007 ◽

Vol 107 (3) ◽

pp. 666-671 ◽

Cited By ~ 36

Author(s):

Susan E. Mackinnon ◽

Brandon Roque ◽

Thomas H. Tung

Keyword(s):

Grip Strength ◽

Median Nerve ◽

Radial Nerve ◽

Nerve Palsy ◽

Nerve Repair ◽

Nerve Transfer ◽

Functional Restoration ◽

Radial Nerve Palsy ◽

Nerve Function ◽

Proximal Forearm

✓The purpose of this study is to report a surgical technique of nerve transfer to restore radial nerve function after a complete palsy due to a proximal injury to the radial nerve. The authors report the case of a patient who underwent direct nerve transfer of redundant or expendable motor branches of the median nerve in the proximal forearm to the extensor carpi radialis brevis and the posterior interosseous branches of the radial nerve. Assessment included degree of recovery of wrist and finger extension, and median nerve function including pinch and grip strength. Clinical evidence of reinnervation was noted at 6 months postoperatively. The follow-up period was 18 months. Recovery of finger and wrist extension was almost complete with Grade 4/5 strength. Pinch and grip strength were improved postoperatively. No motor or sensory deficits related to the median nerve were noted, and the patient is very satisfied with her degree of functional restoration. Transfer of redundant synergistic motor branches of the median nerve can successfully reinnervate the finger and wrist extensor muscles to restore radial nerve function. This median to radial nerve transfer offers an alternative to nerve repair, graft, or tendon transfer for the treatment of radial nerve palsy.

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