A man comes to emergency depament after alcohol binge the previous night and sleeping on arm chair. In the morning he is unable to move his hand and diagnosis of ulnar palsy is made. What is the next line of management?
The first procedure to be adopted in every case of nerve injury is to splint the limb in position which will most effectively relax the affected muscles. Since this patient has developed ulnar nerve palsy Knuckle bender splint should be used. Here EMG after 2 days is useless since changes begin to appear in EMG after 2 weeks of a nerve injury. Also there is no need of open exploration since in a case of neurapraxia transmission of impulses is physiologically interrupted for some time, but recovery is complete in a few days or weeks. Splints used for various nerve injuries: Axillary nerve paralysis : Aeroplane splint Radial nerve palsy : Cock up splint Sciatic or common peroneal nerve palsy : Foot drop splint
Knuckle bender splint
Do EMG study after 2 days
Immediately operate and explore the nerve
Wait and watch