Hand Therapy Objectives following Median Nerve and Ulnar Nerve Repairs.   By Anthony Howley OTR/L, CHT

Post-operative care following end to side AIN to Ulnar Motor Nerve transfer. Splinting at 2-3 days post-op in a wrist extension splint. Hand Therapy begins approximately 2 weeks following suture removal.

Post-operative care following end to side AIN to Ulnar Motor Nerve transfer. Evaluation ROM of joints Functional outcome measures (QDASH, PRWHE..) Sensory Threshold (Semmes Weinstein) MMT of muscle groups (atrophy) Assess claw degree of claw deformity Grip/Pinch strength Patient perceived most difficult functional tasks. Moberg Pick Up Test Pain and hypersensitivity Scar tissue 2 point discrimination Maximum Abduction and Adduction hand tracing on paper

Post-operative care following end to side AIN to Ulnar Motor Nerve transfer. Hand Therapy at 2 weeks post-op. Edema management Scar mobilization techniques Desensitization techniques Sensation Safety education during ADLS Patient education PROM and AROM Begin early Abduction and Adduction exercises of digits Begin early pronation exercises (utilize the Donor muscles)

Post-operative care following end to side AIN to Ulnar Motor Nerve transfer. Progression of Hand Therapy Place and hold intrinsic exercises Anti-claw splinting Thumb IP splinting Sensory re-education BTE Grasping and holding objects Pronation exercises are combined with hand in intrinsic plus position or with Abduction and Adduction of digits. Facilitate the connection between the Donor and Recipient muscles. Resistance of supination by therapist to elicit donor nerve during therapy Progressive Strengthening

Post-operative care following end to side AIN to Ulnar Motor Nerve transfer. First 3 weeks immobilization Repairs at the elbow require a posterior elbow splint Repairs at the forearm, wrist and hand require splinting with wrist in 30 degrees flexion Splint can be adjusted weekly to increase extension Patient education Course of muscle recovery Sensory recovery Safety concerns (temperature, skin care)

Post-operative care following Median Nerve repair. Evaluation ROM of joints Functional outcome measures (QDASH, PRWHE..) Sensory Threshold (Semmes Weinstein) MMT of muscle groups (atrophy) Assess opposition of thumb and fine motor control Grip/Pinch strength Patient perceived most difficult functional tasks. Moberg Pick Up Test Pain and hypersensitivity Scar tissue 2 point discrimination

Post-operative care following Median Nerve repair. Progression of Hand Therapy Sensory re-education Facilitate Cerebral Plasticity Sensory stimulation home program Texture discrimination Vibration Temperature A/AROM, PROM and AROM. (avoid overstretching) C-Bar Splinting Grasping objects/ADLS 6-12 weeks Combined wrist extension with digit extension exercises Strengthening BTE