peripheral nerve injuries of wrist and hand

Question 1

discuss CTS

Answer 1

sensory deficit (tingling) on lateral 3-½ fingers

weakness or atrophy of thenar muscles

palms must have sensations if no inde CTS but more proximal

Question 2

intervention scenario of non op management for CTS

Answer 2

restore: reduce tingling, pins and needles and restore grip of thenar muscles

Question 3

discuss goals in non op management of CTS

Answer 3

nerve protection c splinting

activity mod and pt educ

mobility

muscle performance

sensory re-education

Question 4

give interventions for nerve protection c splinting

Answer 4

night splint to prevent excessive wrist flexion

typing - wrist must be neutral since flex/ext will irritate nerve

Question 5

give interventions for activity mod and pt educ

Answer 5

analysis of faulty motions

modify activities to keep the wrist in neutral

Question 6

give interventions for mobility in CTS

Answer 6

PJM - mob of carpal bones maybe indicated

tendon gliding - improve flexor tendon mob of wrist flexors

ULTT1 or distal median nerve mob

Question 7

give interventions for muscle performance in CTS

Answer 7

resistance and endurance ex - thumb is responsible for 80-90% of hand function

gentle multiple angle muscle sets

speed, coordination, endurance and fine finger dexterity ex

Question 8

give interventions for sensory re-education

Answer 8

re-introducing different sensory modalities (soft, hard, pain, light touch) → apply 5-10 mins each

least irritating to most

Question 9

discuss immob phase for CTS post op

Answer 9

7-10 days

wrist in slight ext and finger free to move

Question 10

discuss maximum phase for CTS post op

Answer 10

avoid active wrist flex/ext in first 2 wks after surgery

c splint

pt educ

wound management, control edema and pain

active tendon and nerve gliding

AROM - avoid active wrist flexion beyond neutral 10 days to 3 wks post op

Question 11

discuss moderate and minimum phase for CTS post op

Answer 11

full activity by 6-12 wks

scar tissue mob - cross fiber massage

progressive stretching and PJM of carpal bones

isoms - 4 wks post op
grip and pinch - 6 wks post op

dexterity ex

sensory stim and discriminative sensory reeducation

Question 12

discuss canal of guyon syndrome

Answer 12

ulnar nerve bet pisiform and hamate

sensory affectation of 1-1/2 medial fingers

weakness of hypothenar muscles

Question 13

discuss non op management for canal of guyon

Answer 13

modify provoking activity

avoid pressure to base of palm

rest c cock-up splint

ulnar nerve mob

Question 14

discuss post op management for canal of guyon

Answer 14

immob for 3-5 days

gentle ROM

Question 15

discuss preventive care after nerve injury

Answer 15

avoid handling hot, cold, sharp or abrasive

avoid sustained grips

change use of tools

thicker handles to redistribute pressure

wear protective gloves

inspect skin regularly

moisturize