Hand and Upper Extremity | OT Notes

Median Ulnar Radial Nerve Injury

    • Radial Nerve Injury
      • Innervates extensor supinator muscles of forearm
      • Low level lesion = wrist drop is the clinical sign
        • Radial = cant keep radiant bracelet on b/c of wrist drop
        • Difficulty manipulating/ releasing objects
      • High lesion = loss of triceps, difficulty extending the elbow
      • Interventions
        • Dynamic extension splint – protect extensor tendons from overstretching and position wrist in functional use
    • Ulnar Nerve Injury
      • Distribution: 1/2 ring + pinky on palmar and dorsal surface
        • Ulnar – think ultimate ulnar fingers
      • Clinical sign: hypertension of MCP joint and flexion of IP joint = CLAW HAND
      • Occupational deficit- loss of power grip + decreased pinch strength
      • Interventions
        • MCP Flexion Block Splint – prevent hyper extension and place MCP in flexion
    •  Median Nerve Injury
      • Distribution: thumb, index, middle, 1/2 ring finger palmar and dorsal surface
        • Median-think middle finger and on
      • Low lesion = APE HAND
        • flattening of thenar eminence and thumb adduction
        • Clawing of index and middle fingers (flexion)
      • High Lesion = Hand of Benediction
        • Trick- “the pope prays to the all high all mighty god and gives hand of benediction for his blessing”
      • Functional Loss: loss of thumb opposition and palmar abduction
      • Interventions
        • Low Lesion-use a dorsal protection splint with wrist in 30 degree flexion
        • High Lesion- add elbow at 90 degree flexion
        • C-Bar to maintain web space and prevent thumb adduction contracture
        • Opponens Splint to position thumb in functional position

Burn Classification and Rehabilitation Occupational Therapy

Ulnar Claw vs Median Hand

  • Claw hand
    • Aka: intrinsic minus hand
    • Hyper extension at MCP and hyper flexion at PIP and DIP (permanent fixed position at rest)
    • Low lesion means losing innervation to the interossei muscles and ulnar lumbrical
      • Lunbricals allow to flex at the MCP and extension at the PIP and DIP and wok with the extensor digitorium to extend the IP joints
    • Lumbricals keep the extensor digitorium accountable – when lumbricals aren’t helping the extensor digitorium goes out of control -> HYPER EXTEND THE MCP JOINTS AND HYPER FLEX THE IP JOINTS
  • Benediction Hand
    • High lesion of median Nerve
    • When attempting to make a fist only digits 4+5 will flex partially
    • Flexor muscles are paralyzed- flexor digitorium superficial, flexor pollicis brevis, flexor pollicis longus
      • Digits 1-3 are unable to flex
    • Not a default position, only seen when asked to close fist
  • Ape Hand
    • High lesion of median Nerve
    • Impairment in thenar muscles-flat thenar eminence and loss of palmar abduction and opposition
    • Default position at rest

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