Therapy
If the nerve is completely severed, surgical reconstruction is required. A special suture technique, the nerve suture, is used for this purpose. If the nerve is severed with long-distance pronounced damage, an autogenous nerve transplantation may be necessary: For this purpose, a less important nerve is taken from another part of the patient’s body and used to bridge the damaged part of the radial nerve.
If the damage is not severed, a conservative approach can usually be taken, i.e. without surgery. It is essential to protect the arm so that the nerve gets the necessary rest to regenerate. For this purpose a (plaster) splint can be applied.
Anti-inflammatory drugs such as ibuprofen or paracetamol should prevent the development of an inflammatory reaction. Under certain circumstances, the injection (injection) of cortisone preparations into the damaged area can be considered. Very important for a fast and complete recovery of the functional ability is an immediately initiated physio- and/or occupational therapy.
If replacement of the nerve by transplantation is not possible, certain surgical restructuring of the hand muscles and tendons can be performed. For example, tendons of muscles that are actually responsible for bending the wrist are shifted to the back of the hand. In these cases, physiotherapy and occupational therapy are particularly important, as the patient must learn that a different muscle is now responsible for stretching than before.
Physiotherapy represents an essential aspect of the treatment of a drop hand. In case of an operation, physiotherapy should be started in the first days after the operation. In the beginning, the main focus is on moving the arm out of the splint.
Otherwise, tendons in particular could scar with the surrounding tissue during the period of immobilization, which would lead to a permanent restriction of mobility that would be difficult to correct. Since immobilization is important for nerve recovery, but also causes the muscles to atrophy, the focus of physiotherapy after removal of the splint is on restoring muscle strength. Occupational therapy is mainly used when the drop hand has been treated by surgical reconstruction of the hand tendons.
Consequently, the patient must now learn to use other muscles if he wants to stretch the hand. To do this, occupational therapists use various exercise techniques that train the coordination between brain, nerve and muscles. There are various splints that can be used.
What they generally have in common is that they keep the wrist slightly stretched to make it easier to lift the hand. However, when choosing a suitable splint, individual anatomical conditions must be taken into account as well as the extent of the drop hand symptoms and whether surgery has been performed. Occupational and physiotherapists often have particularly good knowledge and experience regarding the choice of splint, which is why it is recommended to consult an appropriate therapist before a possible operation.
On this occasion, appointments can also be made directly for treatment after the operation. In general, all exercises in which the extension of the hand and fingers is trained can help. In the first few days, most patients will have more or less difficulty lifting without resistance.
Once a certain training effect has been achieved, resistances can also be used, such as weights that are hung around the hand or fingers, making the exercise more difficult. Have your occupational or physiotherapist demonstrate the exact exercise sequences to you.It should be emphasized that you should also repeat the exercises learned there regularly at home, otherwise it is hardly possible to achieve a significant effect. If you are unsure about how to perform the exercises, do not hesitate to ask the therapist again, so that no ineffective or even harmful movements are introduced. In addition, therapists often have other tricks that can accelerate the regeneration of functions, e.g. setting ice stimuli to improve the sensation of feeling, which may also be impaired.
