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common peripheral nerve problems
Terms in this set (35)
nerve is completely torn at nerve root from spine
nerve is torn but not a spinal attachment
nerve has attempted to heal by conduction is effected by scar tissue
contusion or stretching of nerve-heals without intervention within a few days or weeks
nerve is intact but fibers distal to injury degenerate- recovery can take 6 months
complete laceration of nerve- must be repaired surgically- nerve grafting may be needed
results in transient state of disrupted nerve conduction along the injured segment
involves more sever axon disruption and injury and will take longer to heal if too sever surgery will be required
pathological condition of the peripheral nerve
involves damage to single nerve
multi-focal asymmetrical involvement of multiple nerves
double or multiple crush syndrome
involves serial or dual sites of nerve compression
saturday night palsy
neuropraxia of the radial nerve
when compression resolves and blood supply returns to nerves then causes symptoms of burning, tingling, or pricking sensations
breakdown of the axon distal to the site of injury
primary nerve repair
nerve repair performed the first week or after injury
delayed or secondary nerve repair
nerve repair performed after the first week or more
can be completed with commercial conduit or autograft or allograft
surgical dissection and exploration of a damaged nerve with goal of freeing nerve from local restrictions or adhesions
surgery for when nerve is trapped or impinged in some way
tinel's sign or test
Gentle but firm percussion performed along nerve distribution site ‐
patient will report tingling sensation. Therapist performs from distal
to proximal. Can assist in determining site of nerve recovery.
high radial nerve injury or radial nerve palsy
This injury usually occurs after a humerus fracture. There may be triceps
weakness or the muscles may be fully intact. Main actions affected are
absent wrist extension, weak supination, absent finger extension, absent
thumb extension/abduction, and weak wrist radial deviation. Nerve may
require surgery for repair or may be able to heal in time. Full recovery can
take between 4‐6 months. Saturday night palsy is where the nerve is
compressed overnight and temporary loses nerve conduction. Recovery
may take a very weeks or up to a few months. tendon transfer may be needed
splint for high radial nerve injury
A static splint with wrist and finger extension may be used during day or at
night and a dynamic wrist/finger/thumb extension splint may be worn
during the day. If the nerve is surgically repaired then an elbow splint will
be needed for several weeks.
low motor radial nerve injury (PIN)
This condition is similar to high radial nerve palsy with the exception
that wrist extension is intact. Typically, the main loss is motor and not
sensory in nature.
Radial tunnel syndrome
Injury involves the superficial radial nerve in the forearm. Most
symptoms are sensory in nature consisting of dull aching or burning
pain. Needs to be differentiated from lateral epicondylitis or may occur
with lateral epicondylitis.
superficial radial sensory nerve injury (Wartenburg's syndrome
This injury involves the superficial radial nerve near the wrist.
Symptoms are sensory in nature. Injury may be caused by tight
handcuffs or bracelet or watch on a person's wrist. This condition must
be differentiated from DeQuervain's tenosynovitis.
This injury involves compression of the anterior Interosseous nerve
which is a motor branch of the median nerve. Typically, there are no
sensory symptoms but primarily motor in nature.
Patient may complain of deep diffuse forearm pain, weakness or
paralysis of FPL, FDP (1and 2), and Pronator Quadratus.
Patient will usually have a positive Ballentine's sign (unable to make an
"O" with thumb and index finger).
Pronator Teres Syndrome
This injury involves median nerve compression with the Pronator Teres
in 4 possible locations. Symptoms usually include a diffuse medial
forearm pain and/or dysesthesias of median nerve distribution in hand.
Symptoms may be provoked by resisted elbow flexion and pronation
Low median nerve Syndrome (carpal tunnel or CTS
Median nerve palsy can cause an "Ape Hand" deformity. In this case a static thenar web spacer
splint of C‐bar splint will be needed.
Have patient hold a full fist for 30‐40 seconds with wrist in neutral. If causes severe
pain in intrinsic muscles then the Berger's test is positive meaning that the Lumbricals are
intruding on the carpal tunnel. *Patient may also report that they need to flex their hand
frequently to relieve their pain.
splint needed for low median nerve without berger's
Wrist cock‐up with wrist in neutral
splint needed for low median nerve with positive berger's
If Berger's Test is positive then use wrist cock‐up with MP's blocked at 20‐40 degrees flexion
• When sutures are removed then scar management is needed
• Modalities as appropriate
• Initiate tendon and median nerve gliding exercises and stretching
• Avoidance of repetitive gripping and pinching tasks
• Modification of work or sport activities
• Progressive strengthening program at 3‐4 weeks
low ulnar nerve injury (ulnar tunnel syndrome
This injury involves compression of the ulnar nerve in the Guyon canal which will include sensory loss on volar
side and motor impairment in hand. This injury will usually result in a "claw hand deformity" or clawing the 4th
and 5th digits
positive wartenberg's sign
Fifth digit is held in abducted position.
splint for low ulnar nerve
splint to prevent or minimize clawing
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