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1. Toni Anne Alvarez, Andrew Antonio, Katie Case, Jana Tsuruda,
& Kari Wathen
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. 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
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. 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. (McKee & Nguyen, 2007)
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. 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. 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. 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. 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. 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. 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. 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.