A 40-year old male after binge drinking slept on a chair. On the next day, he presented with weakness of the right arm and was not able to move his hand. Examination showed ulnar nerve palsy. What would be the management?
Ans. b. Give a knuckle bender splint (Ref: Maheshwari 3rd/50, 51)The above patient is most likely suffering from a neuropraxia because of abnormal positioning of limb causing pressure on the ulnar nerve and he is expected to recover spontaneously and completely. However, it may take 3 to 6 weeks, and thus a knuckle bender splint during that time will prevent fixed deformity from developing by keeping the hand in functional position, till the recovery takes place.Splints used in various Nerve InjuriesNerve InjuredSplint UsedAxillary nerve (Deltoid paralysis)Shoulder abduction splintRadial nerve palsyCock-up splintUlnar nerve palsyKnuckle-bender splintSciatic nerve or common peroneal nerve palsyFoot drop splintUlnar Nerve EntrapmentUlnar nerve entrapment is the 2nd MC entrapment neuropathy in the upper extremityQ.MC area for entrapment: Area around the elbow > Wrist at the Guyon canalQNerve Conduction Studies:Electromyography tests and nerve conduction studies are indicated to confirm the area of entrapment, document the extent of the pathology, and detect or rule out the possibility of double crush syndromeQ.Motor and sensory conduction velocities are more useful in a recent entrapment of the ulnar nerveQConduction velocities and EMG are useful in chronic neuropathies because EMG shows axonal degenerationQ.Treatment:Conservative (splint devices, physical therapy, rehabilitation) or surgicalQ.Conservative treatment of ulnar nerve compression is most successful when paresthesias are transient and caused by malposition of the elbow or blunt trauma.Indications for Surgery for Ulnar Nerve EntrapmentNo improvement in presenting symptoms after 6-12 weeks of conservative treatmentProgressive palsy or paralysisClinical evidence of a long-standing lesion (muscle wasting, clawing of 4th and 5th digits)SplintUsed InFour post collar and SOMI (stemo, occipital, mandibular immobilization) braceCervical spine injuryQASHE (Anterior spinal hyperextension) brace and Taylor's braceDorsolumbar spineQMilwaukee brace and Boston braceScoliosisQLumbosacral corsetLow back acheQCock up splintRadial nerve palsyQKnuckle Bender splintUlnar nerveQVolkmann's Turn Buckle splintVolkmann's ischemic contractureQAluminium splintFinger immobilizationQShoulder abduction splintAxillary nerve palsyQAeroplane splintBrachial plexus injuryQDennis Brown splintCTEVQToe raising / Foot drop splintCommon peroneal or sciatic nerve palsyQBohler Brown splintFracture femurQ (anywhere from neck to supracondylar region)Thomas knee splintKnee immobilizationQCrammer wire splintEmergency immobilizationQ
Instant exploration
Give a knuckle bender splint
Electromyography after 2 days and decide after results
Neurolysis
Management In Orthopedics