UL Orthotics - PNI

Question 1

What is the pattern of motor loss for the median nerve? (Hand and elbow)

Answer 1

Hand

• 1st and 2nd Lumbricals
• Interossei still intact
• Abductor Pollicis brevis
• Flexor pollicis brevis (superficial head)
• Opponens pollicis

Elbow

• Flexor carpi radialis
• Palmaris longus
• flexor digitorum superficial.

Question 2

What is the pattern of motor loss for the ulnar nerve?

Answer 2

• hypothenar muscles
• abductor digiti minimi
• opponens digiti minimi
• flexor digiti minimi
• lumbricals to 4th and 5th finger
• dorsal and volar interossei
• flexor pollicis brevis (deep)
• adductor pollicis

Question 3

What is the pattern of motor loss for the radial nerve?

Answer 3

• finger, wrist, and thumb extensors

- abductor pollicis longus

Question 4

What is the pattern of SENSORY loss for the radial nerve?

Answer 4

• Dorsal aspect of thumb
• Dorsum of 2,3, and half of 4th to PIP jt
• if posterior interosseus branch (motor) only, then there is no cutaneous sensory deficit

Question 5

What is the clinical presentation of median nerve palsy?

Answer 5

Ape hand

Thumb looks weirdly laterally extended

Question 6

What is the clinical presentation of ulnar nerve palsy?

Answer 6

Claw hand

Question 7

What is the clinical presentation of radial nerve palsy?

Answer 7

Drop wrist

Question 8

What is the clinical presentation of auxiliary nerve palsy?

Answer 8

Deltoid atrophy

Question 9

Seddon’s Classification: What is neuropraxia?

Answer 9

Least severe injury, is characterized by conduction block (focal conduction block)

Question 10

Seddon’s Classification: what is Axontemesis?

Answer 10

Disruption of axons and surrounding endoneurial sheaths

Question 11

Seddon’s Classification: what is Neurotmeric nerve injury?

Answer 11

Complete transaction

Question 12

What are the goals in the initial 3 weeks after peripheral nerve injury?

Answer 12

• Protect tissue for cell regrowth,
• prevent further injury secondary to decreased sensation, and
• immobilized to minimize inflammation reaction

Question 13

What are the goals in the initial 6 months following peripheral nerve injury?

Answer 13

Prevent joint stiffness and deformities

Question 14

What are the orthotic biomechanical goals when treating peripheral nerve injuries?

Answer 14

• do not place denervated muscles in an overstretched position for long periods,
• prevent joint contractures, and
• prevent development of substitution patterns

Question 15

Wrist immobilization orthotic position for radial nerve injury.

Answer 15

Wrist in 30-40 def extension

Question 16

MCP extension WHO position for radial nerve injury.

Answer 16

Wrist in 30-40 deg extension;

MCPs in dynamic extension

Question 17

Elbow orthosis position for an ulnar nerve injury.

Answer 17

Elbow in 30-45 deg flexion

Question 18

Anticlaw orthosis position for ulnar nerve injury.

Answer 18

4th and 5th MCPs in 30-40 def of flexion

Question 19

Dorsal (volar) WHO position for median nerve injury.

Answer 19

Wrist in neutral

Question 20

Ulnar gutter WHO position for median nerve injury.

Answer 20

Wrist in neutral

Question 21

Thumb web spacer (C-bar) orthosis position for median nerve injury.

Answer 21

Thumb in 40-45 deg of palmar abduction