PNI Flashcards
seddon’s classification of n. injury
neuropraxia
axonotmesis
neurotmesis
based on internal structure of the n.
what is the OT role in all PNI?
determine how bad injury is (temporary?) and tx (splinting)
what are methods of PNI repair?
end to end
bovine tube
nerve graft
muscle (tendon) transfer
when is the tendon muscle transfer option used?
repair/graft not possible
restore balance lost through injury
what are factors that influence regeneration?
mechanical (impenetrable scar) delay in repair age level of injury associated injuries
what is used to check progression of growth?
tinels
what are motor changes after PNI?
decreased muscle weight
increased CT
not contracting/relaxing properly anymore
when is fxnl innervation unlikely?
after 2 yrs
what can help innervation by another n?
NMES (fxnl n. stimulation)
what does amount of thenar eminence atrophy depend on?
proximal injury (more) vs. distal injury
what are early sympathetic changes after PNI?
dry skin that is warm and rosy absent goosebumps slight atrophy blemished nails slow healing
what are late sympathetic changes after PNI?
mottled/cyanotic/cool skin dry/moist no goosebumps non-elastic more atrophy talon nails slow healing
what is the purpose of sensory re-education?
re-train pt to recognize distorted cortical impression
help get proper input
what is the minimal requirement to start sensory re-education?
must have protective sensibility
what is the early phase of sensory re-education?
perception of 30 cps of vibration
and moving touch
what is the late phase of sensory re-education?
moving touch and constant touch is perceived at the fingertips
what is Dellons sensory re-education?
using textures to have pt match sensation
how to tx for hypersensitivity?
- compensation and education
2. sensory desensitization program
what is done within the 1st week of txing PNI?
dressing/cast to position jts (prevent stretching)
AROM of non involved jts
elevation (swelling)
what is done by day 7 of txing PNI?
remove dressing fabricate splint light compression AROM of non involved jts PROM of specific jts (prevent deformity) pt education
how long is pt usually in a splint?
1-3 weeks
what is done 3 weeks post to tx PNI?
PROM to keep jts supple and to promote healing and prevent swelling
splint may have to change
what is done days 7-21 post PNI?
discontinue dressing when wound closes
adjust splint to decrease angle of jts
light activities in splint
what is done days 22-35 after PNI?
discontinue splint with MD ok scar massage/desensitization fxnl activities tinels re-eval sense/motor edema control
what is done for intermediate management of PNI?
NMES
fxnl activities
UE strengthening
sense re-education
what is done for chronic management of PNI?
re-eval goals
prioritize for fxn
decrease deformity
reconstruction options
radial n. deficits
drop wrist
what is prognosis for radial n. injury?
greater potential for normal use of hand
what is the protocol for distal ulnar n. injury?
prevent over stretching of denervated intrinsic muscles of 4th and 5th fingers
what is the protocol for proximal ulnar n. injury?
splinting mandatory
when FDP to 4th & 5th returns, clawing = more evident
ulnar n. deficits
froments sign
median n. deformity
ape hand
