1. Toni Anne Alvarez, Andrew Antonio, Katie
Case, Jana Tsuruda, & Kari Wathen

2. Radial Nerve Palsy
● “Wrist drop”
● Radial nerve innervates the distal musculature for
extension of the wrist and digits
● Caused by a high laceration from a traumatic injury
or midshaft humerus fracture

3. ● 23 y.o. Filipino female
● Referred to outpatient orthopedic occupational
therapy
● Bar fight 8 weeks ago
● Enjoys dancing, cooking, going to the beach,
going to the gym, boxing
● Provided sling for shoulder from doctor resulting
in UE guarding and decreased overhead reach

4. ● D-Ring (acute and night)
● Radial Nerve Palsy Splint
(outpatient)
● Phoenix Extended Outrigger Kit
● Rolyan Static Radial Nerve
Orthosis
● Wrist Extension Immobilization
Orthosis
(www.rehabmart.com)

5. ● Colditz, J.C. (2011). Splinting the hand with a
peripheral nerve injury.
o Radial nerve injury is more commonly injured at the higher level
around the humerus
o Splint must be appropriately designed to harness wrist motion while
allowing finger flexion - vital to normal grasp-and-release pattern
o Advantages of this splint:
 Allows partial wrist motion and full finger motion
 Maintain the normal hand arches
 Thumb and CMC joints are unimpeded
 Absence of material on palmar surface - allows normal grasp
 As function returns, facilitates strengthening of wrist extensors

6. ● McKee, P., Nguyen, C. (2007). Customized dynamic splinting:
orthoses that promote optimal function and recovery after radial
nerve injury: a case report.
o Orthotic intervention addresss both functional needs and biological needs of
the tissues.
o A static volar wrist-hand splint is commonly provided for night use for
positioning the wrist, thumb, and fingers to prevent contractures.
o Tenodesis splints harness active wrist flexion to produce passive finger MCP
extension and conversely harness active MCP flexion to produce passive wrist
extension.
o An advantage over dynamic splints is that tenodesis metal components
closely follow the contours of the hand, thus taking up less space.

7. (McKee & Nguyen, 2007)

8. Name: Radial Nerve Palsy Splint
Purpose: Allowing motion while providing support
● Passive wrist and MCP extension
● Allows active wrist and digit flexion
● Position of wrist extension facilitates power of finger flexion
● Prevent overstretching of denervated muscle
Why chosen:
● Allows functional use of hand through flexion for ADLs, IADLs,
leisure
● Enables FMC

9. Day
● All day (within patient comfort)
● Radial nerve palsy splint
Night
● Consider client sleep schedule
● D- ring splint
Care
● Clean with soap and lukewarm water. Scrub with small brush.
● Rub inside of splint with alcohol to reduce odor.
(www.zmescience.com)

10. S: Pt. reports 4/10 pain in right shoulder. “I cannot get pots and pans
when I cook dinner”.
O: Pt. seen for 45’ OT session. MH right shoulder x 10 min. STM x 5
min. Ther ex x 10 min. Pt education on splint and compensatory
strategies x 10 min. Ther act x 10 min. Wrist ext 20 degrees.
Shoulder flexion 150 degrees.
A: Good increase wrist extension (10 degrees) past week. Limited
shoulder flexion continues to limit household activities.
P: Increase wrist ROM. Decrease pain. Increase overhead reach.

11. Short-Term Goal 1:
Within 2 weeks, pt. will be independent with donning/
doffing splint on ⅘ trials.
Short-Term Goal 2:
Within 2 weeks, pt. will be independent with
compensatory strategies to promote household
activities.

12. ● Axons in the peripheral nervous system have the ability to
regenerate
● Motor supply is restored
● Sensory and sympathetic innervations are restored
● The prognosis for recovery also depends on the extent of
connective tissue damage.
o 1st and 2nd degree injuries have good prognosis
o 3rd-6th degree injuries typically result in incomplete
or failed reinnervation
(www.wikipedia.org)
(Skirven, Osterman, Fedorczyk & Amadio, 2011).

13. Stage One
● Fingers and wrist need to be supported to prevent
shortening of the flexors and overstretching the
extensors
Stage Two
● Motor supply is restored proximal to distal
● Wrist and digit extension remain weak
(Skirven, Osterman, Fedorczyk & Amadio, 2011)

14. WHAT YOU SHOULD KNOW
EBR: Colditz, J.C. (2011). Splintingthehandwitha peripheral nerveinjury.
· Radial nerveinjuryismorecommonlyinjuredat thehigher level aroundthehumerus
· Splint must beappropriatelydesignedtoharnesswrist motionwhileallowingfinger
flexion- vital tonormal grasp-and-releasepattern
Radial NervePalsy Orthotic
Radial NervePalsy
· Alsoknownas
“Wrist drop”
· TheRadial nerve
helpstoextend
(bendback) your
wrist andfingers
· Causescouldbe
fromatraumatic
injurytothe
upper extremity
or fracture.
Radial NervePalsy
Splint
Purpose:
· Allowsmotion
whileproviding
support
· Allowsfunctional
useof thehandto
helpwithactivities
of dailyliving.
· Enablesfinemotor
control.
Splint Wear & Care
Wear:
· For daytimeuse
withinpatient
comfort
Care:
· Cleanwithsoap,
lukewarmwater &
small brush.
· Usealcohol to
helpreduceodor

15. Colditz, J.C. (2011). Splinting the hand with a peripheral nerve injury. In Skirven, T.M., Osterman,
A.L., Fedorczyk, J., & Amadio, P.C. (Eds.), Rehabilitation of the hand and upper extremity (622-
634). Philadelphia, PA: Elsevier, Inc.
McKee, P., & Nguyen, C. (2007). Customized dynamic splinting: orthoses that promote optimal
function and recovery after radial nerve injury: a case report.Journal of Hand Therapy, 20(1),
73-88.
Skirven, T. M., Osterman, A. L., Fedorczyk, J., & Amadio, P. C. (2011). Rehabilitation of the Hand
and Upper Extremity, 2-Volume Set: Expert Consult. Philadelphia, PA: Elsevier, Inc.