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splinting lecture 6
Terms in this set (45)
distal humerus fracture
posterior elbow immobilization orthosis
distal radius fracture
wrist cock-up splint
rested hand splint
intrinsic plus hand splint
terminal branch of the posterior cord of the brachial plexus.
It is the largest branch of the plexus, supplying the majority of the posterior and extensor components of the forearm.
axilla level of radial nerve
cut at Radial N at axilla level
Lose elbow extension, weak supination, absent wrist and finger extension, thumb radial abduction
elbow level (deep branch of radial nerve)
extensor carpi radialis longus/brevis
cut radial nerve at elbow level
Weak supination, lose wrist (radial and ulnar) and absent finger extension, thumb radial abduction.
Intact elbow extension
radial nerve at forearm level
Posterior interosseous nerve PIN: a continuation of the deep branch after the supinator
Extensor digiti minimi
Extensor carpi ulnaris
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
cut radial nerve at forearm level
Lose MP extension thumb/digits and Thumb CMC radial abduction, wrist extension to ulnar side.
Intact elbow extension, supination, and wrist extension to radial side
is a nerve which runs near the ulna bone.
The nerve is the largest unprotected nerve in the human body (meaning, unprotected by muscle or bone), so injury is common.
directly connected to the little finger, and the adjacent half of the ring finger, supplying the palmar side of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.
ulnar N innervates
In the forearm, via the muscular branches of ulnar nerve:
-Flexor carpi ulnaris
-Flexor digitorum profundus (4th, 5th)
In the hand, via the deep branch of ulnar nerve:
-Opponens digiti minimi
-Abductor digiti minimi
-Flexor digiti minimi
-The third and fourth lumbrical muscles
In the hand, via the superficial branch of ulnar nerve:
formed from parts of the medial and lateral cords of the brachial plexus, and continues down the arm to enter the forearm with the brachial artery.
It originates from the brachial plexus with roots from C5, C6, C7, C8, & T1
the only nerve that passes through the carpal tunnel, where it may be compressed to cause carpal tunnel syndrome
medial nerve innervates
all flexor muscles in forearm except flexor carpi ulnaris & part of flexor digitorum profundus
-Flexor carpi radialis
-Flexor digitorum superficialis muscle
The anterior interosseus branch of the median nerve supplies the following muscles:
-Flexor digitorum profundus (index and long)
-Flexor pollicis longus
1st &2nd lumbricals
skin of palmar side of thumb, index, middle, and half of ring finer + nail beds of these fingers
LOAF: lateral 2 lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
loose connective tissue
-contains blood vessels
-protects fascicles from pressure
-allows gliding of fascicles
group of axons containing myelinated/unmyelinated fibers
surrounded by myelin which allows for conduction
temporary loss of motor/sensory function due to blocked nerve conduction
6-8 weeks, good recovery
usual source of injury by blunt injury, external blow
temporary damage to myelin sheath, but nerve remains intact
damage to axon and myelin sheath
schwann cells, endoneurium, perineurium, and epineurium remain intact
occur in more severe crush or contusion than neurapraxia
regenerating nerve fibers 1-2 mm per day, 1 inch a month
most serious injury
partial or complete severance of a nerve, myelin sheath, and CT elements
injury from laceration or traction
requires surgical approximation with uncertain recovery
transection of transverse carpal ligament to decompress nerve
microsurgical suture to repair epineurium
suture end-to- end of nerve
performed on nerve encapsulated in dense scar tissue
removal of scar tissue that compresses nerve into surrounding structures preventing nerve gliding, therefore producing nerve stretching affecting circulation/chemical imbalance
Autograft by a cutaneous nerve
Graft fills in large gap in a nerve, must happen if end-to-end repair is not possible
purpose for splinting for nerve injury
-avoiding tension on surgical repair
-decreasing pressure on nerve (external/internal)
-prevent elongation of non-innervated muscles
Assist with Function
radial nerve palsy
The most commonly injured of the 3 major peripheral nerves in the upper arm.
Most common cause is direct trauma to nerve from fractures of the humerus or elbow dislocations.
External compression in the axilla or along the mid-humeral level can result in neuropathy.
Radial Nerve is more vulnerable about mid-humeral level as it transverses around the spiral groove of the humerus, moving medially to laterally.
high radial nerve palsy (elbow)
Elbow Extension is intact; weak supination .
Paralysis of all wrist extensors, loss of finger extension at the MP joints and inability to extend and radially abduct the thumb.
"Wrist Drop Deformity"
low radial nerve palsy (PIN) forearm
Radially directed wrist extension but absent finger MP joint extension, thumb extension, and thumb radial abduction.
radial nerve tenodesis
A functional tenodesis grasp is the opposition of the thumb and index finger.
The main focus of therapy is to achieve a functional tenodesis grasp either with an active or passive wrist extension
The ideal splint would recreate the harmony of tenodesis action: finger extension with wrist flexion and wrist extension with finger flexion.
non-operative treatment for radial nerve toneless
1. PROM and AAROM
2. full movement in gravity eliminated and hold exercises (isometric)
3. isotonic strengthening to correct proximal weakness once adequate muscle strength is noted
4. muscle retraining
- joint protection
- proper positioning
radial tunnel syndrome
A condition caused by compression of the radial nerve between radial head and supinator muscle.
Caused by repetitive forearm motion
non-operative treatment for radial tunnel syndrome
Splinting: volar wrist immobilization, elbow... only immobilize what's needed to decrease symptoms
-Pain free, active assisted and PROM
-4-6 weeks until strengthening
*repetitive forceful wrist extension and supination should be avoided at all times
cubital tunnel syndrome
Therapy Hint: Ulnar nerve compression at the cubital tunnel of the elbow is the second most common site of nerve entrapment in the UE. ☺
Signs/Symptoms: pain occurs along the medial aspect of the elbow and tenderness over the cubital tunnel.
Parasthesias in the ring and small finger are present
Motor weakness and wasting of the ulnar-innervated intrinsic muscles are present in more severe cases.
Decreased power grip and decreased pinch strength
Severe cases: clawing of the ring and small fingers resulting from paralysis of the ulnar innervated interossei and lumbrical muscles and the unopposed pull associated antagonist muscle, EDC.
non-operative treatment for cubital tunnel syndrome
Splinting: Static long arm resting splint.
--Elbow should be in 30-45 of elbow flexion and forearm and wrist in neutral.
ulnar tunnel syndrome or entrapment at guyon's canal
Ulnar tunnel at the wrist (Guyon's Canal) contains the ulnar nerve and artery and fatty tissue.
Canal is bounded by the pisiform and tendinous insertion of the flexor carpi ulnaris ulnarly and the hook of the hamate radially.
Roof of the canal is the flexor retinaculum.
non-operative treatment for ulnar tunnel syndrome or entrapment at guyon's canal
-Prevents overstretching of the denervated lumbrical muscles and interossei of the ring and small fingers
-Remove only for hygiene
anterior interosseous nerve palsy
Entrapment of the motor branch of the median nerve compression of deep head of pronator teres
Signs/Symptoms:inability to make an O with thumb and index no sensory loss.
Compression at two heads of pronator teres, caused by strong/repetitive pron/sup
Diffuse pain in the medial forearm or distal volar arm along with dysethesias (bad sensations) in the radial three and one-half digits of the hand
Symptoms are provoked by resisted elbow flexion with concurrent resisted pronation.
non-operative treatment for medial nerve injuries
Splinting: fabricate a splint to rest irritated tissues. (elbow/wrist)
Median nerve compression occurs in the carpal tunnel. Carpal tunnel is a narrow channel with median nerve and nine extrinsic flexor tendons to the digits and the thumb pass through.
Signs/Symptoms: nocturnal pain and dysesthesias, diminished fine motor coordination, intermittent daytime numbness and tingling and in advanced cases thenar weakness with significantly decreased pinch strength. tinels positive at wrist, phalens
More in women than men
Bilateral Symptoms more common
50% of cases occur in persons between 40-60 years of age
causes of CTS
Fluid retention from systemic states such as pregnancy or endocrine d/o
Space occupying lesions such as ganglions or tumors
Systemic medical conditions such as RA, DM or trauma to the wrist.
non-operative treatment for CTS
Splinting: Wrist Cock Up Splint.
-Wrist in neutral with the wrist at 0-20 degrees of flexion and about 3 degrees of ulnar deviation.
Nerve Glides/Tendon Gliding
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