Hand Therapy Objectives following Median Nerve

and Ulnar Nerve Repairs. 

ByAnthony Howley OTR/L, CHT

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. 

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

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)

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

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)

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

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