3. Classification of Nerve Injury Seddon’s surgical model and Sunderland’s anatomic model Myelin Axon Endoneurium Perineurium Epineurium I Neuropraxia +/- II Axonotmesis Y Y N N N III Y Y Y N N IV Y Y Y Y N V Neurotmesis Y Y Y Y Y VI (Mackinnon & Dellon) various fibers/ fascicles, mixed pathologic change
22. Anticlaw splint maximum MP joint flexion MCP joint flexion spring splint – strengthening EDC can be extend around thumb metacarpal to maintain thumb web
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28. Initial therapy : protection of joints, surrounding ligaments and tendons, from further stress
Patient use of long finger flexor instead of adductor
Splints, slings, or both may be used in these cases. For example, a radial nerve injury results in a loss of wrist and finger extension, a wristdrop. A wrist-resting splint may be used to support the hand in a neutral wrist position and place the hand in a more functional position. In patients with. The hormone erythropoietin has been used with some success to accelerate function use after an injury. 9 , 10 Physical therapy is started in the early stages following nerve injury to maintain passive range of motion in the affected joints and to maintain muscle strength in the unaffected muscles. No definitive studies have been done to support the use of electrical muscle stimulation to prevent muscle degeneration. In cases of muscle denervation, galvanic direct current stimulation is necessary to elicit a muscle contraction. The risks of galvanic stimulation include a thermal burn beneath the electrodes. Because no studies have shown that external stimulation will stop total degeneration of the muscle fibers and/or neuromuscular junction, the authors do not believe that direct current stimulation is worth the risk of a thermal burn. If the nerve does not regenerate in time to reinnervate the muscle, there is no need to stimulate the muscle. With reinnervated muscle, it is theoretically possible to use alternating current stimulation. However, it is necessary to have a large number of reinnervated muscle fibers to stimulate the muscle with alternating current. The authors recommend exercise and biofeedback strategies to increase the strength of a reinnervated muscle.
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