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

2. 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.

3. 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

4. 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)

5. 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

6. 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)

7. 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

8. 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