If you are currently awaiting or have recently undergone hand nerve repair. Patient information digital nerve repair this sheet answers common questions about a digital nerve repair. Digital nerve repair you have had small nerve repaired in your fingerthumb. A plaster of paris splint maybe applied to hold your fingers in the most comfortable position and to protect the nerve repair. Understanding the various approaches to tendon repair rehabilitation is complex and challenging this course aims to present the latest and greatest evidence, including clinical pearls for splinting, digital nerve involvement, scar management. Huber jl, maier c, mainka t, mannil l, vollert j, homann hh. The assessments included 2point discrimination 2 pdstatic dynamic, semmesweinstein monofilament, and range of motion as shown on table 8. If a digital nerve has been repaired in conjunction with the fpl repair, the dorsal blocking splint may be adjusted into increased flexion if necessary.
After nerve injury, there are immediate changes in the peripheral. Queensland with a bachelor of occupational therapy in 2007. You report code 64831 suture of digital nerve, hand or foot. Qld workers compensation scheme hand injury statistics. Physical therapy standards of care and protocol the following standards of care and protocols are the property of bwh and should not be copied or otherwise used without the permission of the director of rehabilitation services. Jamess hospital median and ulnar nerve repair protocol. The traditional options of nerve repair include direct nerve suture and nerve graft repair.
A splint will have been made for you to wear at all times for the next 3 weeks. Continued therapy rehabilitation will focus on strengthening and improving hand function. Rehabilitation protocols southeast georgia health system. Following digital nerve repair, the patients underwent 1 of 3 postoperative rehabilitation protocols as in table 5. In ultrasound therapy group 1 protocol, out of 36 digits. Postoperative mobilization regimens following digital nerve. 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.
Rehabilitation of the upper extremity following nerve and. Presenting over 100 rehabilitation protocols for the hand and upper extremity in an easytouse, stepbystep format, this practical reference provides surgeons and therapists alike with a goto source for the therapy technique or strategy appropriate for their patients. Placehold for hook, full and straight fist with wrist extended. Median and ulnar nerves traumatic injuries rehabilitation. Wear splint fulltime except for when performing therapy exercises. Rehabilitation of the upper extremity following nerve and tendon. Primary digital nerve repair following sharp transection of nerve clearly described postoperative rehabilitation protocol digital nerve repair as the primary outcome measure exclusion criteria outcome of other injures i. Techniques and options in nerve reconstruction and repair. Niamh feeney, senior occupational therapist joanne finn, senior physiotherapist. Splint joint proximal and distal to repair in 20 degrees flexion dorsal block splint unless otherwise instructed.
Table 1 nerve reconstruction was performed using a commercially available processed nerve. Arthroplasty contractures fractures fusions ligament dislocation nerve repairs nerve compression syndromes replantation tendinitis. 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. Covid19 coronavirus the health and safety of our patients and staff have always been and remains our top priority. The result is a wonderful book that will be valuable to both clinicians and basic scientists. Obviously, the choice between one protocol and another is a matter. The intent of posting these standards of care and protocols is to provide clinicians and patients an understanding of our current standards of care and protocols at bwh. This will protect your hand and help the nerve to heal. When reporting nerve repairs, you wont need to labor over the number of sutures your surgeon may place. The importance of the timing of therapeutic intervention to the results of zone ii flexor tendon repairs was retrospectively studied.
This image guides your orthopaedic surgeon as he used specialized instruments through the arthroscope to repair any damage. 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. Performance study of an artificial nerve guide reaxon nerve. Outcome of surgical repair of adult digital nerve injury. Pdf early ultrasound therapy for rehabilitation after.
Manual tactile test predicts sensorimotor control capability of hands for patients. The incisions in the hand will be closed with stitches and a dressing and bandage applied. It would also greatly lessen the chances of your hand recovering fully. A quick test includes testing the autonomous zone of the median nervethe index finger volar tip. Digital nerve reconstruction with axogen avance processed. Fashion a shortarm dorsal blocking splint holding the wrist in neutral, mp joints of the injured. Emphasize passive stretches to compensate for motor loss. How do we treat rotator cuff pathology with manual therapy. The goal of occupational therapy is to assist you in your recovery and return to.
After 7 days, neuroma at divided nerve ends just be. Passive movement became the standard form of therapy. Postoperative instructions for flexor tendon repair. While we do not anticipate significant swelling following this procedure, it. The techniques of nerve repair follow, including a section on harvesting autologous nerve grafts, because these grafts remain the most appropriate and proven intervention for the repair of lengthy nerve injury gaps in humans. A prospective randomized study comparing woven polyglycolic acid and autogenous vein conduits for reconstruction of digital nerve gaps. In all cases, a doctor will explain the operation to you and answer any questions you may have. Digital nerve repair, scar tissue resection, and soft tissue release were also performed during the. Twostage flexor tendon reconstruction in zone ii using. 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. As well, the therapist will fabricate a hand based splint to be worn at all times to protect the nerve repair. Sensory recovery outcome after digital nerve repair in. Postoperative instructions for flexor tendon repair purpose of surgery.
Week 6 appointment made for occupational therapy department for full sensory assessment. Immediate repair if suitable operative candidate b. Twentytwo patients were categorized as having had either early intervention referral within the first postoperative week or delayed intervention referral between 1 and 3. In order to have a more accurate diagnosis and obtain more reliable information about the location, severity and prognosis of peripheral nerve injury, is fund amental to perform an electroneuromyography exam. Presenting over 100 rehabilitation protocols for the hand and upper extremity in an easytouse, stepbystep format, this practical reference provides surgeons and therapists alike with a goto sourc. Surgery and rehabilitation for primary flexor tendon. Rehabilitation protocols the protocols listed below were developed by southeast georgia health system physicians and therapists and are intended for use by clinicians and patients alike. The wound is explored and may require extending to find the nerve ends. Delayed repair after 7 days if patient is unstable or graft needed d. Fds fdp flexor tendon repair twin cities orthopedics.
This book is a huge undertaking by a single author who is an. Flexor tendon repair therapy protocol 3 of 5 continue dbs, unless patient shows unresponsive flexion lag watch for pip flexion contracture. In all cases, a doctor will explain the operation to. A digital nerve repair is a procedure where the skin is opened surgically and the nerve is repaired using a microscope. If the principle pathology of the tendon is a tear, there is nothing that manual therapy can do that directly helps this condition. Splint three weeks to avoid tension on the nerve repair, with elevation to minimize swelling 2. Arthroscopy is a minimally invasive surgical procedure that uses an arthroscope thin, flexible tube to access your affected joints and project an image of them on large screen. Michelle o donnell, clinical specialist occupational therapist.
These protocols are listed by diagnosis, so clinicians who are providing patient care may reference the applicable protocol to help rehabilitate their patients condition. Digital nerve repair south bend orthopaedics, indiana. Eligibility criteria adult digital nerve injury in which either direct repair or no repair was undertaken and an outcome measure was recorded. Recovery of mechanical detection thresholds after direct digital nerve repair versus conduit implantation. 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. 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. Flexor tendon repair and rehabilitation have posed challenges to surgeons and therapists for decades. Flexor tendons are required to glide large distances to allow the digits full composite flexion and extension, running within a tight pulley system to maximize their efficiency fig. This cast will help control swelling and protect your hand.
The autonomous zone for a single digital nerve is the ulnar or radial side of the digit at the level of the middle phalanx. The postoperative protocol followed our standard replantation protocol. Pdf the recovery of functional sensibility after nerve transection and repair is often disappointing. In some cases, surgeons have advocated only the initial operative dressing following digital nerve repair.
Jan 17, 2014 postoperative mobilization regimens following digital nerve repair. Continue therapy 23 times per week until week 6 or full rom and. Therapy of the hand and upper extremity springerlink. 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. Digital nerve injuries are a common consequence of penetrating hand injuries and are typically managed by direct microsurgical repair following exploration and wound debridement.
Following surgical nerve repair, your hand will be immobilized with a splint. The initial goal of therapy is to regain motion in stiff joints. Manual therapy treatment for a pathologic rotator cuff tendon depends on which tendon is affected, the pathology of the tendon, and what signs and symptoms are accompanying the problem. At your first therapy visit, some of your wound dressings may be removed. Apr 30, 2019 a prospective randomized study comparing woven polyglycolic acid and autogenous vein conduits for reconstruction of digital nerve gaps. The most important concern about flexor tendon repair is avoiding use of the injured hand for any type of gripping. Place hold for isolated fds glide of involved digits. She also had a laceration of the radial digital nerve of the thumb, index and middle fingers together with a laceration of the common digital nerve extending to the third web space, a pisiform fracture and small fracture of the volar aspect of thumb at the level of the interphalangeal joint. Infection can occur, requiring antibiotics and further treatment. Therapy of the hand and upper extremity rehabilitation. Digital nerve repair reconstructive orthopedics, sewell, nj. Digital nerve repair nerve repair can help restore sensation and muscle function, however, in many cases normal sensation and function is not fully restored.
Flexor tendon repair therapy protocol sideline orthopedics. All nerve grafts remained intact after mobilization. If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor. Effects of delayed therapeutic intervention following zone. They were then followedup at various time points as shown in table 7. If your hand is swelling then keep it up in the air as much as possible. Jan 17, 2014 the primary outcome used to measure digital nerve recovery following digital nerve repair was sensibility table 8, which is assessed by static and dynamic 2point discrimination, and semmes weinstein monofilament testing. Data extraction and synthesis study data extracted included demographics, injury type and extent, timing, treatment details, outcome data and time points, adverse outcomes, hand therapy and return to work.
Discuss with your surgeon if the nerve repair was with or without tension. 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. Hand nerve injury and repair physical therapy patient. Range of motion exercise after 3 weeks, avoiding stretching or trauma to. Good clinical outcome after digital nerve repair is highly relevant for proper hand function and has a significant socioeconomic impact. Urgent repair if skin wound closed and repair delayed up to 7 days, then repaired primarily c. Postoperative mobilization regimens following digital nerve repair.
The purpose of this book is to provide the orthopedic sur geon and hand surgeon. This may be initiated at any time during the course of therapy. A total number of 76 subjects with traumatic digital nerve injuries in whom surgical repair may not allow endtoend direct suture of the nerve ends, and in whom the nerve tissue gap would indicate the use of an autograft of equal or less than 26 mm, are eligible for inclusion. Digital nerve repair bobbie posted mon 03rd of february, 2014 17. Patient information digital nerve repair amazon s3. However, we conclude that splinting beyond the immediate postoperative period, following repair of sharp, uncomplicated digital nerve divisions is unnecessary. You will begin therapy when your doctor deems that nerve healing is sufficient. This book incorporates new techniques that have an effect on the most precious part of the cranium, the brain. Risks of a digital nerve repair there are risks and complications with this procedure. If other soft tissues have been repaired in the surgical procedure, the duration of. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Jun 01, 2015 the study will be performed in specialized german centers. The protocols listed below were developed by southeast georgia health system physicians and therapists and are intended for use by clinicians and patients alike. Antideformity splinting to compensate for loss of motor function commenced.
Splinting and protocol to include the involved and adjacent digits. 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. Primary nerve repair by endtoend coaptation can be performed in about 82% of patients with common digital nerve lacerations. 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.
Flexor pollicis longus repair early passive motion program. If other soft tissues have been repaired in the surgical procedure, the duration of immobilization may be prolonged to allow for sufficient healing of these tissues. Digital nerve repair orthopedic coding ask an expert. Currently there is a multiplicity of postoperative mobilitybased rehabilitation protocols following isolated digital nerve repair. The technique is reported in clinical studies for digital nerve. Starting at 3 weeks, gradually increase mp joint extension by 15 degrees weekly. Treatments for hand injuries and conditions the curtis. Allograft reconstruction for digital nerve loss volume 38, issue 10, october 20, pp. A nerve injury with a tendon injury may require greater protection. Twostage flexor tendon reconstruction using a silicone rod in the first stage and a free.
The hand to elbow clinic 29a james street west bath ba1 2bt. Right hand therapy rehabilitation of the repaired tendon. However, level of evidence for competing surgical techniques is low. Median and ulnar nerves traumatic injuries rehabilitation 263 sometimes resulting in falsenegative or falsepositive diagnosis. Postoperative mobilization regimens following digital. If you have any questions your occupational therapist will be happy to assist. Gripping can cause the tendon to rupture, which would require another surgery. Seventeen patients with 21 digital nerve lacerations. Exercises progressed to combined wrist and finger extension stretch.
1542 327 888 1205 255 1566 103 187 1539 202 1342 432 822 1087 754 856 1160 1043 81 338 1234 603 1316 430 1466 21 859 474 66 692 1371 1333 1497 879 641 1229 624