1. 1. Toni Anne Alvarez, Andrew Antonio, Katie Case, Jana Tsuruda, & Kari Wathen
2. 2. Radial Nerve Palsy Wrist drop Radial nerve innervates the distal musculature for extension of the wrist and digits Caused by a high laceration from a traumatic injury or midshaft humerus fracture
3. 3. 23 y.o. Filipino female Referred to outpatient orthopedic occupational therapy Bar fight 8 weeks ago Enjoys dancing, cooking, going to the beach, going to the gym, boxing Provided sling for shoulder from doctor resulting in UE guarding and decreased overhead reach
4. 4. D-Ring (acute and night) Radial Nerve Palsy Splint (outpatient) Phoenix Extended Outrigger Kit Rolyan Static Radial Nerve Orthosis Wrist Extension Immobilization Orthosis (www.rehabmart.com)
5. 5. Colditz, J.C. (2011). Splinting the hand with a peripheral nerve injury. o Radial nerve injury is more commonly injured at the higher level around the humerus o Splint must be appropriately designed to harness wrist motion while allowing finger flexion - vital to normal grasp-and-release pattern o Advantages of this splint: Allows partial wrist motion and full finger motion Maintain the normal hand arches Thumb and CMC joints are unimpeded Absence of material on palmar surface - allows normal grasp As function returns, facilitates strengthening of wrist extensors
6. 6. McKee, P., Nguyen, C. (2007). Customized dynamic splinting: orthoses that promote optimal function and recovery after radial nerve injury: a case report. o Orthotic intervention addresss both functional needs and biological needs of the tissues. o A static volar wrist-hand splint is commonly provided for night use for positioning the wrist, thumb, and fingers to prevent contractures. o Tenodesis splints harness active wrist flexion to produce passive finger MCP extension and conversely harness active MCP flexion to produce passive wrist extension. o An advantage over dynamic splints is that tenodesis metal components closely follow the contours of the hand, thus taking up less space.
7. 7. (McKee & Nguyen, 2007)
8. 8. Name: Radial Nerve Palsy Splint Purpose: Allowing motion while providing support Passive wrist and MCP extension Allows active wrist and digit flexion Position of wrist extension facilitates power of finger flexion Prevent overstretching of denervated muscle Why chosen: Allows functional use of hand through flexion for ADLs, IADLs, leisure Enables FMC
9. 9. Day All day (within patient comfort) Radial nerve palsy splint Night Consider client sleep schedule D- ring splint Care Clean with soap and lukewarm water. Scrub with small brush. Rub inside of splint with alcohol to reduce odor. (www.zmescience.com)
10. 10. S: Pt. reports 4/10 pain in right shoulder. I cannot get pots and pans when I cook dinner. O: Pt. seen for 45 OT session. MH right shoulder x 10 min. STM x 5 min. Ther ex x 10 min. Pt education on splint and compensatory strategies x 10 min. Ther act x 10 min. Wrist ext 20 degrees. Shoulder flexion 150 degrees. A: Good increase wrist extension (10 degrees) past week. Limited shoulder flexion continues to limit household activities. P: Increase wrist ROM. Decrease pain. Increase overhead reach.
11. 11. Short-Term Goal 1: Within 2 weeks, pt. will be independent with donning/ doffing splint on trials. Short-Term Goal 2: Within 2 weeks, pt. will be independent with compensatory strategies to promote household activities.
12. 12. Axons in the peripheral nervous system have the ability to regenerate Motor supply is restored Sensory and sympathetic innervations are restored The prognosis for recovery also depends on the extent of connective tissue damage. o 1st and 2nd degree injuries have good prognosis o 3rd-6th degree injuries typically result in incomplete or failed reinnervation (www.wikipedia.org) (Skirven, Osterman, Fedorczyk & Amadio, 2011).
13. 13. Stage One Fingers and wrist need to be supported to prevent shortening of the flexors and overstretching the extensors Stage Two Motor supply is restored proximal to distal Wrist and digit extension remain weak (Skirven, Osterman, Fedorczyk & Amadio, 2011)
14. 14. WHAT YOU SHOULD KNOW EBR: Colditz, J.C. (2011). Splintingthehandwitha peripheral nerveinjury. Radial nerveinjuryismorecommonlyinjuredat thehigher level aroundthehumerus Splint must beappropriatelydesignedtoharnesswrist motionwhileallowingfinger flexion- vital tonormal grasp-and-releasepattern Radial NervePalsy Orthotic Radial NervePalsy Alsoknownas Wrist drop TheRadial nerve helpstoextend (bendback) your wrist andfingers Causescouldbe fromatraumatic injurytothe upper extremity or fracture. Radial NervePalsy Splint Purpose: Allowsmotion whileproviding support Allowsfunctional useof thehandto helpwithactivities of dailyliving. Enablesfinemotor control. Splint Wear & Care Wear: For daytimeuse withinpatient comfort Care: Cleanwithsoap, lukewarmwater & small brush. Usealcohol to helpreduceodor
15. 15. Colditz, J.C. (2011). Splinting the hand with a peripheral nerve injury. In Skirven, T.M., Osterman, A.L., Fedorczyk, J., & Amadio, P.C. (Eds.), Rehabilitation of the hand and upper extremity (622- 634). Philadelphia, PA: Elsevier, Inc. McKee, P., & Nguyen, C. (2007). Customized dynamic splinting: orthoses that promote optimal function and recovery after radial nerve injury: a case report.Journal of Hand Therapy, 20(1), 73-88. Skirven, T. M., Osterman, A. L., Fedorczyk, J., & Amadio, P. C. (2011). Rehabilitation of the Hand and Upper Extremity, 2-Volume Set: Expert Consult. Philadelphia, PA: Elsevier, Inc.