DISCUSS THE ORTHOTIC MANAGEMENT OF HIGH RADIAL NERVE PALSY ?
An INTRODUCTION
1 RADIAL N IS THE MOST INJURED NERVE OUT OF 3 NERVES OF UPPER EXTREMITY
2 IT IS MOST VULNERABLE TO DAMAGE AT MID HUMERAL LEVEL SINCE IT SUPERFICIALLY WRAPS AROUND THE SPIRAL GROOVE
3 THE MOST COMMON CAUSE OF DAMAGE BEING DIRECT INJURY
HIGH RADIAL N PALSY
1 REFERS TO THE INJURY OF RADIAL N IN SPIRAL GROOVE
2 IN THIS TRICEPS MUSCLE IS SPARED RESULTING IN NO LOSS OF ELBOW FUNCTION
3 THERE WILL BE LOSS OF INNERVATION TO BRACHIORADIALIS AND SUPINATOR MUSCLE , ALL WRIST EXTENSORS , ALL EXTRINSIC FINGER EXTENSORS AND ALL EXTRINSIC THUMB ABDUCTORS
4 IN THIS THERE WILL BE INABILITY TO EXTEND AND STABILISING THE WRIST RESULTING IN INABILITY TO USE LONG FLEXORS ADEQUATELY IN MAKING A FIST
5 PALM SENSITIVITY WILL BE INTACT WHICH IS IN CONTRAST WITH THE ULNAR AND MEDIAN N PALSY IN WHICH SENSATION IS ALSO IMPAIRED
6 PERIOD OF RECOVERY IS FROM 5 WEEKS TO 8 MONTHS
FEATURES OF IDEAL SPLINT
CREATION OF HARMONY BETWEEN FINGER EXTENSION WITH WRIST FLEXION AND WRIST EXTENSION WITH FINGER FLEXION
ORTHOTIC MANAGEMENT
1 PRIORITY BEING STABILISATION OF WRIST WITH PRESERVATION OF POWER GRIP
2 STATIC SPLINT NOT RECOMMENDED AS IT FORMS CONTRACTURE ON PROLONGED USE
3 THE MOST POPULAR OF SPLINT DESIGN BEING - THOMAS SUSPENSION SPLINT BECAUSE IT EXTENDS THE WRIST , FINGER AND THUMB
4 OTHER MOST POPULAR SPLINT BEING OPPENHEIMER SPLINT
5 RECOMMENDED SPLINT - GRANGER SPLINT - IT IS BIOMEDICALLY SIMILAR BUT INSTEAD OF STRINGS DESIGNED FOR TENDONS IT HAS STATIC LINING AND FINGER LOOPS DIRECTLY ATTACHED TO OUTTRIGGER
ADVANTAGES OF STATIC LINING -
1 DOES NOT ALLOWS THE WRIST TO DROP BELOW THE NEUTRAL
2 MAINTENANCE OF NORMAL ARCH OF HAND
3 ABSENCE OF SPLINTING MATERIAL ON PALMAR ASPECT , THUS ALLOWING FULL SENSORY INPUT FOR GRASPING
4 A COMPARATIVE LOW PROFILE AS IT IS LESS BULKY