Neuropathy Treatment Guidelines

Radial Neuropathy

Draping and Positioning

  • Put into neuropathic position
    • elbow flexed, wrist flexed, shoulder adduction and elbow pronation
  • Take out of that position and put onto a pillow
    • elbow extended, elbow supinated and wrist extended
    • do NOT put into more flexion

Specific Treatment

  • Begin with Tinel’s down Radial nerve path
    • Deltoid to brachioradialis to base of thumb
    • Tell client to let you know if they feel a sensation and where do they feel it
  • Work on high tone in wrist flexors, do NOT compress the nerve
  • Flaccid in wrist extensors and triceps, facilitated techniques
  • Perform 4 engrams
    • Triceps activation
    • Wrist extension
    • Finger extension
    • Wrist supination

Communication

  • Ask specifically if any sensation is felt
  • Check in on safety and comfort
  • Make sure no pressure or stretch to nerve

Medial Neuropathy

Draping and Positioning

  • Put into neuropathic position
    • Supinate forearm, extend wrist, extend 2nd and 3rd fingers
  • Take out of position and put on pillow
    • Pronate forearm, slightly flex the elbow and neutral hand
  • Do NOT put into more supination, extension and thumb adduction

Specific Treatment

  • Tinel’s down Median nerve path
    • Medial epicondyle between the tendons of the FDS
    • Tell client to let you know if you feel any sensation and where
  • Work on high tone in wrist extensors
  • You will see flaccidity in wrist flexors and pronators
  • Perform 4 engrams
    • wrist flexion
    • wrist pronation
    • finger flexion of 2nd finger
    • finger flexion of 3rd finger

Ulnar Neuropathy

Draping and Positioning

  • Put into neuropathic positions
    • Extrinsic finger extension, flexion at PIP and DIPs at 4th and 5th digits
  • Take out of position and put on a pillow
    • Flex MCP at the 4th and 5th digit, extension of IP at 4th and 5th digits, keep elbow slightly flexed, don’t abduction shoulder

Specific Treatment

  • Tinel’s down Ulnar nerve path
    • Olecranon to ulnar border of the hand
    • Ask client to tell you if they feel any sensation and where
  • High tone will be in the wrist extensors
  • Flaccidity will be in the wrist flexors – facilitation techniques

Overall Neuropathy Notes

  • Communicate about comfort
  • Perform short, cross-fibre strokes
  • Don’t compress flaccid muscles
  • Perform vibration and tapping with engrams
  • Don’t stretch the nerve
  • Off help for them when. getting off the table and remind them to be careful

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