Lecture 16 Nerve Intervention

Motor Disturbances - Coordination and timing of Movement
Deficits in fine motor control - pinch grip force inability to modulate force occurs in presence of neuropathy of both wrist and elbow
Neuroplastic changes in somato-sensory cortex (if not recovering)

Mostly negative!
thenar wasting
increasing symptom duration
bilateral symptoms
+ phalens sign reproduction of symptoms

health status and comorbidities
time with deficits without return

need to instruct the patient in the mechanisms of stretch or compression to the injured nerve and how to avoid
need to instruct the patient in the importance of rest/dietary habits and sleep to optimize recovery
education on time for healing to occur (1mm/day)

-prescribe at rehab level so low dosing to ehance motor control and coordination
40-50% Rep Max with 20-30 reps of 2-3 sets
-prescribe at hypertrophy level for restoration of muscle strength - but don't cause too much fatigue
60-85% rep max with 8-12 reps and 2-3 sets watching for limited loss of coordinated movement
eccentric exercise in weak muscles that cannot perform repetitions against gravity
-Aerobic Exercise! - enhances regrowth, 15-20 mins a day, 5 days a week

e stim at low frequency - facilitates motor recovery when combines with therex
position sense + movement retraining when injury involves nerves that innervate a joint
-joint position sense and end point accuracy with laser training

hot/cold
textures
vibration
tactile sensation using various sensory inputs facilitates recovery

splingting and bracing early - movement compresses nerve in the tunnel
heat - not great evidence
assistive technology - less harsh on the hands when typing
constantly re evaluate bc the longer the nerve is not healing the less likely it is to come back

splinting
education
tendon gliding Ex

manual therapy/stretching
exercise upper extremity
modalities

intrinsic hand - lumbricals, small thumb muscles, interossei to improve precision grip and fine motor control
-dose for endurance but limit fatigue, 3x15-20
tendon gliding with controlled wrist - multiple times throughout day
wrist extension motor control
ST and Shoulder exercise

manual stretching or mob to 1st rib, upper thoracic spinal segments
breathing re education

surgical excision of 1st rib
scalene release or excision
clavicle resection
pec minor release

appropriate surgical choice for appropriate patient
70% good to excellent results

no long term difference