PNI

Question 1

seddon’s classification of n. injury

Answer 1

neuropraxia
axonotmesis
neurotmesis
based on internal structure of the n.

Question 2

what is the OT role in all PNI?

Answer 2

determine how bad injury is (temporary?) and tx (splinting)

Question 3

what are methods of PNI repair?

Answer 3

end to end
bovine tube
nerve graft
muscle (tendon) transfer

Question 4

when is the tendon muscle transfer option used?

Answer 4

repair/graft not possible

restore balance lost through injury

Question 5

what are factors that influence regeneration?

Answer 5

mechanical (impenetrable scar)
delay in repair
age
level of injury
associated injuries

Question 6

what is used to check progression of growth?

Answer 6

tinels

Question 7

what are motor changes after PNI?

Answer 7

decreased muscle weight
increased CT
not contracting/relaxing properly anymore

Question 8

when is fxnl innervation unlikely?

Answer 8

after 2 yrs

Question 9

what can help innervation by another n?

Answer 9

NMES (fxnl n. stimulation)

Question 10

what does amount of thenar eminence atrophy depend on?

Answer 10

proximal injury (more) vs. distal injury

Question 11

what are early sympathetic changes after PNI?

Answer 11

dry skin that is warm and rosy
absent goosebumps
slight atrophy
blemished nails
slow healing

Question 12

what are late sympathetic changes after PNI?

Answer 12

mottled/cyanotic/cool skin
dry/moist 
no goosebumps
non-elastic more atrophy
talon nails
slow healing

Question 13

what is the purpose of sensory re-education?

Answer 13

re-train pt to recognize distorted cortical impression

help get proper input

Question 14

what is the minimal requirement to start sensory re-education?

Answer 14

must have protective sensibility

Question 15

what is the early phase of sensory re-education?

Answer 15

perception of 30 cps of vibration

and moving touch

Question 16

what is the late phase of sensory re-education?

Answer 16

moving touch and constant touch is perceived at the fingertips

Question 17

what is Dellons sensory re-education?

Answer 17

using textures to have pt match sensation

Question 18

how to tx for hypersensitivity?

Answer 18

1. compensation and education

2. sensory desensitization program

Question 19

what is done within the 1st week of txing PNI?

Answer 19

dressing/cast to position jts (prevent stretching)
AROM of non involved jts
elevation (swelling)

Question 20

what is done by day 7 of txing PNI?

Answer 20

remove dressing
fabricate splint
light compression
AROM of non involved jts
PROM of specific jts (prevent deformity)
pt education

Question 21

how long is pt usually in a splint?

Answer 21

1-3 weeks

Question 22

what is done 3 weeks post to tx PNI?

Answer 22

PROM to keep jts supple and to promote healing and prevent swelling
splint may have to change

Question 23

what is done days 7-21 post PNI?

Answer 23

discontinue dressing when wound closes
adjust splint to decrease angle of jts
light activities in splint

Question 24

what is done days 22-35 after PNI?

Answer 24

discontinue splint with MD ok
scar massage/desensitization
fxnl activities
tinels
re-eval sense/motor
edema control

Question 25

what is done for intermediate management of PNI?

Answer 25

NMES
fxnl activities
UE strengthening
sense re-education

Question 26

what is done for chronic management of PNI?

Answer 26

re-eval goals
prioritize for fxn
decrease deformity
reconstruction options

Question 27

radial n. deficits

Answer 27

drop wrist

Question 28

what is prognosis for radial n. injury?

Answer 28

greater potential for normal use of hand

Question 29

what is the protocol for distal ulnar n. injury?

Answer 29

prevent over stretching of denervated intrinsic muscles of 4th and 5th fingers

Question 30

what is the protocol for proximal ulnar n. injury?

Answer 30

splinting mandatory

when FDP to 4th & 5th returns, clawing = more evident

Question 31

ulnar n. deficits

Answer 31

froments sign

Question 32

median n. deformity

Answer 32

ape hand