When reporting nerve repairs, you wont need to labor over the number of sutures your surgeon may place. This manual is designed to guide the diagnosis and treatment of nerve injuries. Median and ulnar nerves traumatic injuries rehabilitation. Ulnar and radial nerve injuries in the finger are the most common type of hand nerve injury. A splint will have been made for you to wear at all times for the next 3 weeks. Passive movement became the standard form of therapy. Rehabilitation protocols southeast georgia health system. Arthroplasty contractures fractures fusions ligament dislocation nerve repairs nerve compression syndromes replantation tendinitis.
Week 6 appointment made for occupational therapy department for full sensory assessment. Flexor tendon injury an overview sciencedirect topics. The early reeducation group received this book on the first week, and the control group received it when sensory reeducation started 3 months post nerve repair. Functional disability due to nerve lesions is intertwined with severity of lesion. The aim of surgical treatment for the injured, diseased or dysfunctional hand is to. If you have any questions your occupational therapist will be happy to assist. Digital nerve reconstruction protocol dip joint fusion protocol dupuytrens contracture protocol fdp avulsion protocol flexor tenolysis protocol gamekeepersskiers thumb protocol hemi hamate procedure protocol joint release protocol mallet injury protocol mcp joint replacements protocol metacarpal and phalangeal fractuers protocol mucousread more.
The tendons run up the front of the finger in a tunnel flexor sheath which is lined by synovium, a lubricating tissue which allows the. Rehabilitation focuses on appropriate postoperative splinting protocols with the. Edema control is initiated with a light compressive dressing to the hand and forearm, along with digital level fingersocks or. Postoperative instructions for flexor tendon repair purpose of surgery. Nerve regrowth in the peripheral nervous system is dependant on type of injury. Radial nerve injuries can lead to radial nerve palsy, which can cause pain and a loss of function in the arm, wrist, hands, and fingers. If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor.
Primary nerve repair by endtoend coaptation can be performed in about 82% of patients with common digital nerve lacerations. Two studies using cadaveric models of digital nerve repair, where various segments of nerves were resected and then repaired, have shown that as long as the resected segments of digital nerves are less than or equal to 2. This section includes hand therapy protocols, sorted out by diagnosis and. A dorsal blocking safe position splint holding the mp joints in 60 degrees of flexion but allowing ip extension and flexion is constructed for continual wear. Fashion a shortarm dorsal blocking splint holding the wrist in 20 degrees of. Postoperative mobilization regimens following digital nerve repair. Early passive mobilization after digital nerve repair and. This cast will help control swelling and protect your hand. Thumb mp or basal joint fusion therapy digital nerve repair therapy.
Ulnar side and radial side nerve injuries in the finger are the most common type of hand nerve injury. Another treatment option to manage your nerve damage is transcutaneous electrical nerve stimulation tens. Currently there is a multiplicity of postoperative mobilitybased rehabilitation protocols following isolated digital nerve repair. The purpose of this book is to provide the orthopedic sur geon and hand. Flexor pollicis longus repair early passive motion program duran program mordick c rubber band postoperative rehabilitation 3 days postop the bulky compressive is removed. Flexor tendons general there are 2 tendons acting on each finger to bend or flex the finger. When you suffer from peripheral neuropathy, or nerve damage, you have a variety of options like pain relievers or lidocaine patches. The aim is to summarize and compare the outcomes of digital nerve repair with different methods endtoend and endtoside coaptations, nerve grafts, artificial conduit, vein, muscle, and. Cuts, pressure, stretching, or crush injuries can injure the nerves in the hand. The purpose of this case report is to describe the physical therapy postoperative management of a patient who underwent a multiple tendon transfer to correct the loss of digital wrist extension of the right upper extremity.
Postoperative rehabilitation protocol following ulnar. Good clinical outcome after digital nerve repair is highly relevant for proper hand function and has a significant socioeconomic impact. Rehabilitation of the upper extremity following nerve and. Why make a manual solely devoted to nerve repair in the brachial plexus and. Place hold for isolated fds glide of involved digits. Management of flexor tendon injuries in hand intechopen. The initial postoperative protocol following nerve repair, grafting, or transfer are similar. A variety of protocols for flexor tendon rehabilitation have been developed over the past 50 years, making the choice of which protocol to use difficult. While we do not anticipate significant swelling following this procedure, it. Fds flexor digitorum superficialis, superficial tendon flexes the pip joint fdp flexor digitorum profundus deep tendon flexors all joints in the finger. The book addresses primarily surgeons in the fields of hand, plastic. Digital nerve repair south bend orthopaedics, indiana. Rehabilitation protocols and physical therapy wright.
If your hand is swelling then keep it up in the air as much as possible. Recent studies have introduced the concept of lowfrequency nerve stimulation and increased axonal regeneration after nerve repair. Obviously, the choice between one protocol and another is a matter. Postoperative instructions for flexor tendon repair. Rehabilitation after periphera l nerve repair in the hand the traumatic transection of median or ulnar ne rve in the hand usually results in function impairment and represents a major problem for the patient. Michelle o donnell, clinical specialist occupational therapist. Early sensory reeducation of the hand after peripheral. More men experience hand nerve injuries than women. Physical therapy zones 25 flexor tendon repair protocol timelinesplint therapeutic exercise precautionsother week 3 may initiate serial static pip extension splints at night if needed. Post repair therapy protocols page 1 of 10 l019d hand therapy protocols following are representative protocols for each of the three basic approaches to flexor tendon post repair management.
The digital fibrous pulley system keeps the flexor tendons close to the bone. You report code 64831 suture of digital nerve, hand or foot. Patient information digital nerve repair this sheet answers common questions about a digital nerve repair. Exercises progressed to combined wrist and finger extension stretch. An injured nerve can cause a lack of sensation, movement, or both.
Tendon gliding exercises after tendon repair promotes intrinsic mechanism of. Flexor tendon repair therapy protocol sideline orthopedics. Antideformity splinting to compensate for loss of motor function commenced. Patient information digital nerve repair amazon s3. Once muscle reinnervation has occurred, the use of.
After your flexor tendon repair surgery selfcare and followup wound care right after your surgery, you will be in a long arm cast that extends from your fingertips to above your elbow. Digital nerve repair you have had small nerve repaired in your fingerthumb. A study by fakin et al indicated that in epineurial coaptation of digital nerves in adults, the level of success at longterm followup with regard to sensory outcome is related only to the surgeons level of experience and not to such factors as the patients age, whether or not the patient smokes, the time of immobilization, the mechanism of injury, or anastomosis of a digital artery. The goal of preparing this book was to gather such pertinent chapters to. There has been a recent trend on social media attacking the use of protocols and the clinicians that utilize them. But many factors, such as associated lesions skin loss, vascular, nerve injury or. Physical therapy protocols the use of protocols has been around for years in the rehabilitation world.
These types of injuries result most frequently from falls, vehicle crashes, gunshot wounds, and other sources of physical trauma. These protocols are listed by diagnosis, so clinicians who are providing patient care may reference the applicable protocol to help rehabilitate their patients condition. Seventeen patients with 21 digital nerve lacerations. Sensory recovery outcome after digital nerve repair in. Muscle imbalance and weakness can become so severe that the involved extremity can be rendered nonfunctional. Postoperative mobilization regimens following digital nerve. Before reading this article it would be advised to have a good knowledge of the type of lesion and the denervation consequences 1. Fashion a shortarm dorsal blocking splint holding the wrist in neutral, mp joints of the injured. However, level of evidence for competing surgical techniques is low. Splint three weeks to avoid tension on the nerve repair, with elevation to minimize swelling 2. Postoperative physical therapy management of tendon. There may well be a case for the use of an extension block splint after nerve repair when a significant section of nerve has been lost. Table 1 nerve reconstruction was performed using a commercially available processed nerve.
Placehold for hook, full and straight fist with wrist extended. The conditions for a successful nerve repair consist of generous trimming of the nerve until healthy substance is observed, minimal handling, a tensionfree coaptation, and maintaining a wellvascularized wound bed. Bonejoint arthroplasty joint replacement mcp joint arthroplasty joint replacement pip joint arthroplasty thumb cmc joint bony mallet closed or open reduction and fixation carpometacarpal cmc joint fracturedislocation finger partial removal finger phalanx fracture open reduction and internal fixation finger phalanx fracture closed reduction and pinning fusion of finger joint. A nerve injury with a tendon injury may require greater protection. Digital thumb and finger opening requires metacarpophalangeal and.
Hand nerve injury and repair physical therapy patient. In all cases, a doctor will explain the operation to. This section includes hand therapy protocols, sorted out by diagnosis and procedure, based on a joint project with kathy detemple otr cht and richard grisard otr cht. Jamess hospital median and ulnar nerve repair protocol. The sensory and motor recovery after a nerve repair takes long time, and with active use of the hand and training, improvements can be seen several years after the injury. Allograft reconstruction for digital nerve loss volume 38, issue 10, october 20, pp. Regional nerve blocks in anesthesia and pain therapy. Range of motion exercise after 3 weeks, avoiding stretching or trauma to. Postoperative mobilization regimens following digital. However, we conclude that splinting beyond the immediate postoperative period, following repair of sharp, uncomplicated digital nerve divisions is unnecessary. Fds fdp flexor tendon repair twin cities orthopedics. Discuss with your surgeon if the nerve repair was with or without tension. This will protect your hand and help the nerve to heal. Flexor pollicis longus repair early passive motion program.
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