This document outlines the median and ulnar nerve repair protocol at St. James's Hospital from weeks 0-8 after injury. It details the splinting protocols, including fabricating wrist-based splints in the initial weeks and progressing to different splints as range of motion increases. Exercises are progressed over time from passive range of motion to combined wrist and finger stretches to strengthening. Patients receive ongoing occupational and physical therapy, sensory assessments, scar management, and splint modifications to improve function and prevent deformities over the next two years.

1. St. James’s Hospital
Median and Ulnar Nerve Repair Protocol
Written and reviewed by:
Michelle O Donnell, Clinical Specialist Occupational Therapist.
Liza Fitzgerald, Senior Occupational Therapist.
Niamh Feeney, Senior Occupational Therapist
Joanne Finn, Senior Physiotherapist.
Mairead Gibbons, Senior Physiotherapist.
Colm Quinn, Senior Physiotherapist.
Approved by:
Consultant Plastic Surgeons, SJH.
Effective from: May 2017 Review date: June 2018
Week 0 – 4
Median Nerve Splint
Fabrication of Wrist based splint.
Wrist in neutral. MCP, PIP, DIP joints not included. (Wrist Flexion 10-20°
if tight repair)
Ulnar Nerve Splint
Fabrication of Splint
Immobilisation of Wrist in Neutral and MCP joints of ring and little in 70°
Flexion
Two hourly active/passive flexion and active extension of all fingers and
thumb (EAM) within limitations of splint commenced.
Scar management as indicated.
Week 4
Commence active and passive ROM exercises out of splint to facilitate
increased ROM and function.
Active ROM of Wrist
Scar management and skin care.
Review of splint as required
Median Nerve: thumb spica splint if indicated to maintain 1st
web space.
Ulnar Nerve: Change splint to Dorsal based hand splint to prevent hyper
extension of MCP joints.
Avoid combined wrist and digit extension.
Education and advice re motor/sensory loss.

2. Functional use of the hand encouraged.
Assistive equipment recommended if required.
Refer to local therapist with protocol.
Week 6
Appointment made for Occupational Therapy Department for full sensory
assessment.
Exercises progressed to combined wrist and finger extension stretch.
Night splint modified as indicated.
Week 8
Can commence strengthening exercises.
Anti-deformity splinting to compensate for loss of motor function commenced.
Onwards
Regular review in occupational therapy and physiotherapy for up to two years.