Skip to main content

WRIST DROP ( RADIAL NERVE PALSY )

Image
Dr. M. RAJESH, PT, B.P.T, M.P.T(cardio-pulmonary)

 

Radial nerve palsy:

Radial nerve palsy is a condition that affects the radial nerve. The radial nerve starts in upper arm and runs down to wrist and fingers. It controls arm and hand move and feel. This condition may go away over time or may always have it.





causes:
  • Pressure:
    • Devices: Devices that press on the radial nerve may cause damage. For example, crutches can put pressure on the nerve in the armpit. A watch can put pressure on the nerve at the wrist.
    • Awkward body positions: Awkward body positions can also put pressure on the nerve. For example, sleep on  arm or leave it draped over the back of a chair for several hours.


    • Bruises: A bruise that is caused by an injury may put pressure on the radial nerve.
    • Growths: Tumors or cysts (lumps) inside your wrist or arm may press against the nerve.
  • Fractures (breaks) or dislocations: If you fracture the bone in upper arm, it may damage the radial nerve. Dislocations happen when joints (where 2 bones meet) in the shoulder or elbow slip out of place. This can also damage the radial nerve.


  • Cuts on your wrist or arm: Cuts can damage or separate the radial nerve.

signs and symptoms:

Signs and symptoms depend on where the nerve is damaged.

  • Weakness or numbness: Patient may have weakness or numbness from  triceps down to fingers. patient may not be able to make a fist. patient may not be able to straighten elbow, or extend fingers. Patient may begin to lose muscle in  upper or lower arm and it may look smaller.



  • Wrist drop: This is when Patient wrist hangs down limply and  cannot lift it.




  • Pinch and grasp problems: Patient may not be able to bring  thumb and fingers together (pinch) to grasp objects.

Diagnosis:

Healthcare provider will ask  questions about  symptoms and when they began. He may touch and move arm and hand to see which muscles are affected. Patient may also have any of the following:

  • X-rays: Patient may need x-rays to check for broken bones or foreign objects in arm.
  • Magnetic resonance imaging: This test is called an MRI. An MRI may be used to look at the soft tissues and blood vessels in arm, and to check for cysts or masses. Patient will need to lie still during this test. The MRI machine contains a very powerful magnet. Never enter the MRI room with any metal objects. This can cause serious injury.
  • Electromyography and nerve conduction studies: Electromyography (EMG) and nerve conduction studies (NCSs) are tests that measure the electrical activity of  muscles.  Muscles are tested at rest and while using them. An EMG test may also check the nerves that control muscles. NCSs check if radial nerve is working more slowly than normal.

MANAGEMENT:

Recovery time depends on how badly the nerve was damaged. It may take weeks to months for a nerve to heal. In some cases, it may take up to a year to regain normal movement and feeling in  arm or hand. It may need these or other treatments:

  • Pain medicine: Patient may be given medicine to take away or decrease pain. Do not wait until the pain is severe before take medicine.
  • Splint or cast: Patient may need a splint or cast to help support  wrist and hand while the radial nerve heals. A splint or cast helps extend  fingers and wrist so it can use them as much as possible.



  • Physical therapy: Physical therapy helps you with special exercises. These exercises help make bones and muscles strong and flexible.
  • Transcutaneous electrical nerve stimulation: This therapy applies a gentle electric current to muscles and may help reduce pain.
  • Surgery: Patient may need surgery to repair the radial nerve.

 

Physiotherapy treatment:

Peripheral nerve injuries affect a wide range of functional, manual and social function, and frequently lead to constant disabilities. After complete transection of nerve, axonal degeneration process gives rise to a variety of symptoms including hyperesthesia, reduced or altered sensation, pain and atrophy (Lee and Wolfe, 2000). With an array of choices for surgical and treating peripheral nerve injuries, there is also, a lot of new, coherent strategies on rehabilitation and physiotherapy protocols – which should be indispensable after injury. Physiotherapy, with a view to compensate dysfunctions relieves in sensory symptoms and creates grater neuroplasticital potential, forms essential part of the treatment for people after peripheral nerve injuries (Inoue et al., 2003).

In the physiotherapeutic methods, protocols, and strategy currently used for initiation and support of peripheral nerve regeneration after injuries.

Kinetic therapy in peripheral nerve injuries: Impact of kinetic therapy on peripheral nerve repair after its damage is mostly determined by the time required for regeneration of nerve fibers as well as for muscle reinnervation. Stress put on a paralyzed muscle through stretching or strengthening delays, and may even prevent full nerve recovery, and such treatment should not be started until the late stage of nerve regeneration, when progressive strength return can be seen. After injury of the nerve, physiotherapeutic methods are dedicated to eliminate paresis and to restore normal function of muscles as well as to improve circulation and following energetic supply to the tissues.

Electrostimulation: Electric stimulation plays an important role in the treatment of various neuromuscular dysfunctions. With a wide range of applications and the possibility of combining this method with others, it is considered as one of the most effective. There are many types and ways of electrostimulation which differ one from another with the technical embodiment. The most common method is transcutaneous electrical nerve stimulation (TENS), which consists of transcutaneous stimulation pulses of electric current with a frequency of 90–130 Hz.

Chen et al. (2001) showed that percutaneous electric stimulation of 2 Hz frequency enhanced the mean values of the axon density, blood vessel number, blood vessel area and percentage of blood vessel area in total nerve area in injured rat sciatic nerve. As studies show, stimulation current of low frequency (20 Hz) for 1 hour a day for 2 weeks after the injury shortens the period of axonal outgrowth of three nerve bundles through the implanted graft (Al-Majed et al., 2000; Gordon et al., 2003. It also showed that electrical stimulation has a positive influence on regeneration processes by stabilizing the cholinergic receptors at the neuromuscular junction.

Electroacupuncture is a simple method of indirect application of an electrical stimulation to injured nerve. Pomeranz and Campbell (1993) revealed that the regeneration of injured nerve was enhanced by continuous electrical stimulation at the site of the injury via chronically implanted electrodes. However, Inoue et al. (2003) showed that it is unclear whether electroacupuncture enhanced the axonal regeneration processes.

Magnetotherapy: For the treatment of damaged peripheral nerve, a pulsed low frequency magnetic field can also be applied. Magnetic field therapy has well-known effects on enhancing enzymatic activity, oxy-reductive processes and better blood circulation what results in better oxygenation and conduction characteristics of regenerating peripheral nerves. These mechanisms base on the influence of magnetic field on liquid-crystal structure of many membranes and cell organelles resulting in ion-channels transmission changes. Alteration in intra- or extracellular ion distribution leads to changes in electric potentials in organella membranes as well as in cellular membranes of living biological systems. Magnetic stimulation enhances the regeneration of nerve fibers, as the nerve conductivity increases as well as the amplitude of the action potential (Negredo et al., 2004; Mert et al., 2006). The pulsed electromagnetic field (PEMF) has a high clinical value, as applied immediately after peripheral nerve injury – shortens the duration of functional defects (Mert et al., 2006). Unlike electrical stimulation, magnetic stimulation carries no risk of infection due to electrodes pinned around the wound, and it is completely painless, even in patients with well-preserved sensation. Therapeutic effects of PEMF and CEMF in the case of peripheral nerve damage are comparable and may be used complementarily (Bannaga et al., 2006).

Spatial magnetic field generator is one of most recent achievements among the magnetostimulators. Prototype generates magnetic field through 3 pairs perpendicularly arranged magnetic coils. This allows for the interference of fields and results in obtaining the rotational magnetic field focused in small area. This new method may be more effective than other widely used techniques of magnetostimulation and magnetotherapy, as shown in animal experiments where strong spatial alternating magnetic field exerted positive effect on peripheral nerve regeneration. This improvement was found in all experimental groups, with best outcome observed in group exposed to the strongest magnetic field. Also dorsal root ganglion survival rate and nerve regeneration intensity were significantly higher in the group treated with the strongest field (Suszyński et al., 2014).

Bio-laser stimulation: For the treatment of peripheral nerve injury, low energy biostimulation lasers are used, applied in the way of pulsatile (905 nm), continuous (808 nm), or pulsing-constant rays. Laser therapy increases the formation of ATP, and the energy of the ATP hydrolysis can be used by nerve cell to restore normal transmembrane potential, which facilitates the generation of electrical impulses and thereby restoring nerve conduction (bioelectric effect). Application of laser beams improves microcirculation and hence nutrition and regeneration of nerve cells – bio-stimulation effect – and increases the release of endorphins and the concentration of neurotransmitters in the synapses – analgetic effect.

Laser radiation can also be used to rejoin the nerve stumps (Lanre method – laser-assisted nerve repair). Studies evaluating the use of this method show comparable or even more effective reconstruction then surgical treatment. Less scar formation is observed in the site of anastomosis, which creates favorable conditions for the regeneration of nerve fibers (Huang and Huang, 2006). There are also promising results of the coupled use of fiber membranes or Gore-Tex™ with laser beams. This aids in assembling the ends of the nerve, and affects the speed and efficiency of the regeneration process. Application of laser irradiation (Ga-As laser) in the site of the anastomosis inhibits the degeneration process, accelerate remyelination, and nerve function recovery (Bae et al., 2004; Miloro et al., 2002).

One of the major complications of peripheral nerve damage is the formation of a neuroma at the end of the proximal stump. Biostimulation with CO2 or Neodymium-Yag lasers reduces the risk of its formation, or at least alleviates severe pain caused by the formation of a neuroma (Kuzbari et al., 1996).

Therapeutic use of ultrasounds (US) gave some promising results in animal experiment (Raso et al., 2005). However, before this technique might be implemented in human therapy, it is indispensable to precisely elucidate the influence of the US on nervous tissue, as well as to determine the most effective and safest therapeutic protocol that could be used in clinical practice.

In general, there is a lack of randomized, good quality data representing results of clinical application of particular therapeutic methods using standardized dozymetry. Current research encompassing treatment and intervention in nerve injuries is limited, consisting mostly of descriptive and exploratory studies. Especially nonsurgical or post-surgical physical therapy is poorly understood by many physical therapists and even physicians, many clinicians fail to recognize that such nerves often need considerable time to regenerate.


THOSE ABOVE ARE COLLECTED FROM SOME WEBSITES.

THANK YOU,

SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER

Labels:

Comments

Post a Comment

Popular posts from this blog

முதுகு வலி மற்றும் முதுகு தண்டுவட வலி உள்ளவர்களுக்கு கடைபிடிக்க வேண்டிய சில வழிமுறைகள்....

Dr. M. RAJESH, PT, B.P.T, M.P.T(cardio-pulmonary)
  முதுகு வலி மற்றும் முதுகு தண்டுவட வலி உள்ளவர்களுக்கு கடைபிடிக்க வேண்டிய சில வழிமுறைகள் ....     பொதுவாக முதுகு வலி என்பது இன்றைய காலகட்டத்தில் பல பேருக்கு மிக அதிகமாகவே காணப்படுகிறது. இவ்வாறு வலி இருக்கும் பொழுது என்ன மாதிரியான வழிமுறைகளை கடைப்பிடிக்க வேண்டும் என்பதை கீழே விரிவாக பார்க்கலாம்.   பொதுவாக முதுகு வலி ஆரம்பிக்கும் பொழுது அவற்றை உதாசீனப்படுத்தாமல் அருகில் உள்ள மருத்துவரை அணுகி ஆலோசனை பெறுவது மிகவும் முக்கியம். மேலும் முதுகு வலி ஏற்படும் பொழுது அவற்றுக்கு தேவையான மருத்துவம்(medical management), இயன்முறை மருத்துவம்(physiotherapy treatment), பயிற்சிகள்(exercises) அல்லது அறுவை சிகிச்சை(surgery) மற்றும் புனர்வாழ்வு சிகிச்சைகள்(Rehabilitation) போன்றவை தேவைப்படலாம். மேலே கண்ட மருத்துவத்தில் ஏதாவது ஒன்றை எடுத்துக் கொள்ளும் பட்சத்தில் மேலும் முதுகு வலி வராமல் பாதுகாத்துக் கொள்ளவும், நமது அன்றாட வேலைகளை தொடர்ந்து செய்யவும், மருத்துவ உபகரணங்களை பயன்படுத்திக் கொள்ளவும்...
Post a Comment
Read more

BRONCHIECTASIS

Dr. M. RAJESH, PT, B.P.T, M.P.T(cardio-pulmonary)
INTRODUCTION: Bronchiectasis means abnormal dilatation of the bronchi due to chronic airway inflammation and infection. It is usually acquired, but may result from an underlying genetic or congenital defect of airway defences. CAUSES: Congenital • Cystic fibrosis • Primary ciliary dyskinesia • Kartagener’s syndrome (sinusitis and transposition of the viscera) • Primary hypogammaglobulinaemia Acquired • Pneumonia (complicating whooping cough or measles) • Inhaled foreign body • Suppurative pneumonia • Pulmonary TB • Allergic bronchopulmonary aspergillosis complicating asthma • Bronchial tumours CLINICAL FEATURES: ● Chronic cough productive of purulent sputum.  ● Pleuritic pain. ● Haemoptysis.  ● Halitosis. Acute exacerbations may cause fever and increase these symptoms. Examination reveals coarse crackles caused by sputum in bronchiectatic spaces. Diminished breath sounds may indicate lobar collapse. Bronchial breathing due to scarring may be heard in advanced disease. INVESTIG...
1 comment
Read more

லம்பார் ஸ்பாண்டிலோஸிஸ்(lumbar spondylosis)

Dr. M. RAJESH, PT, B.P.T, M.P.T(cardio-pulmonary)
  முன்னுரை ல ம்பார் ஸ்பாண்டிலோஸிஸ்(lumbar spondylosis) எனப்படும் மருத்துவ பிரச்சினைகள் என்பது முதுகுப் பகுதியில் ஏற்படும் நீண்ட நாள் முதுகு வலி. இவ்வாறு ஏற்படும் முதுகு வலி முதுகு முள்ளெலும்பு பகுதியில்(vertebral coloum) உள்ள தட்டு அழுத்தப் படுவதினால்(disk compression) அல்லது முள்ளெலும்பு பகுதியின பிரதான பகுதி சற்று இடம் நகர்வதால(displacement) முதுகு வலி ஏற்படுவதற்கு வாய்ப்புகள் உள்ளதாக கூறப்படுகின்றன. சில சமயங்களில் முதுகு தண்டு மற்றும் எலும்பு பகுதிகள் தொடர்சிதைவு(degeneration) ஆகும் போதும், முதுகெலும்பு தட்டு பகுதி, முதுகெலும்பு மூட்டு(facet joints) பகுதி தொடர்ந்து பிரச்சனைக்கு உள்ளாக்கப்படும் பொழுதும் முதுகு வலி ஏற்படுகிறது. ஸ்பாணடிலோஸிஸ் என்பதை முதுகு எலும்பு தேய்மானம்(osteoarthritis)  எ ன்று கூறலாம். இவ்வாறு முதுகு எலும்பு தேய்மானம்,  ல ம்பார்(lumbar vertebrae)  எனப்படும் கீழ் முதுகு எலும்பு பகுதிகள், மேல் முதுகு எலும்பு பகுதிகள்(thoracic vertebrae), மற்றும் கழுத்து முதுகெலும்பு(cervical vertebrae) பகுதிகள் போன்றவற்றை பாதிக்கலாம். பொதுவாக ஸ்பாண்டிலோசிஸ் எனப்படு...
2 comments
Read more

CARDIAC REHABILITATION

Dr. M. RAJESH, PT, B.P.T, M.P.T(cardio-pulmonary)
  Introduction “Cardiac Rehabilitation is the process by which patients with cardiac disease, in partnership with a multidisciplinary team of health professionals are encouraged to support and achieve and maintain optimal physical and psychosocial health. The involvement of partners, other family members and carers is also important”. Cardiac rehabilitation is an accepted form of management for people with cardiac disease. Initially, rehabilitation was offered mainly to people recovering from a myocardial infraction (MI), but now encompasses a wide range of cardiac problems. To achieve the goals of cardiac rehabilitation a multidisciplinary team approach is required. The multidisciplinary team members include: Cardiologist/Physician and co-coordinator to lead cardiac rehabilitation Clinical Nurse Specialist Physiotherapist Clinical nutritionist/Dietitian Occupational Therapist Pharmacist Psychologist Smoking cessation counsellor/nurse Social worker Vocational counsellor Clerical Ad...
Post a Comment
Read more

CARDIAC ARREST AND RESUSCITATION

Dr. M. RAJESH, PT, B.P.T, M.P.T(cardio-pulmonary)
INTRODUCTION: The leading causes of sudden death before old age, in people over the age of 44, are ventricular fibrillation from asymptomatic ischaemic heart disease or non-traumatic accidents such as drowning and poisoning. In people under the age of 38, the commonest causes are traumatic, due to accident or violence. In such instances death may be prevented if airway obstruction can be reversed, apnoea or hypoventilation avoided, blood loss prevented or corrected and the person not allowed to be pulseless or hypoxic for more than 2 or 3 minutes. If, however, there is circulatory arrest for more than a few minutes, or if blood loss or severe hypoxia remain uncorrected, irreversible brain damage may result. Immediate resuscitation is capable of preventing death and brain damage. The techniques required may be used anywhere, with or without equipment, and by anyone, from the lay public to medical specialists, provided they have been appropriately trained. Resuscitation may be divided in...
1 comment
Read more

RELAXED POSITIONS FOR BREATHLESS PATIENTS

Dr. M. RAJESH, PT, B.P.T, M.P.T(cardio-pulmonary)
Relaxation positions for the breathless patient  If patients can be taught how to control their breathing during an attack of dyspnoea, this can be of great benefit to them. The patient should be put into a relaxed position, and encouraged to do ‘diaphragmatic’ breathing at his own rate. The rate of breathing does not matter at this stage; it is the pattern of breathing that is important. As the patient gains control of his breathing he should be encouraged to slow down his respiratory rate. Any of the following positions will assist relaxation of the upper chest while encouraging controlled diaphragmatic breathing. They can be adapted to various situations in everyday life. HIGH SIDE LYING  Five or six pillows are used to raise the patient’s shoulders while lying on his side. One pillow should be placed between the waist and axilla, to keep the spine straight and prevent slipping down the bed. The top pillow must be above the shoulders, so that only the head and neck are supp...
Post a Comment
Read more

PARKINSON'S DISEASE

Dr. M. RAJESH, PT, B.P.T, M.P.T(cardio-pulmonary)
  Parkinson's EtiologyParkinson's disease (PD) is a neurodegenerative disorder that mostly presents in later life with generalized slowing of movements (bradykinesia) and at least one other symptom of resting tremor or rigidity. Other associated features are a loss of smell, sleep dysfunction, mood disorders, excess salivation, constipation, and excessive periodic limb movements in sleep (REM behavior disorder). PD is a disorder of the basal ganglia, which is composed of many other nuclei. The striatum receives excitatory and inhibitory input from several parts of the cortex. The key pathology is the loss of dopaminergic neurons that lead to the symptom .  It is the seconds most common neuro-degenerative condition in the world after Alzheimer's. The condition is caused by the slow deterioration of the nerve cells in the brain, which create dopamine. Dopamine is a natural substance found in the brain that plays a major role in our brains and bodies by messag...
Post a Comment
Read more