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Post Op Nerve Repair Immobilization
49 Plays1 hour ago
In this episode, Miranda and Josh dive into the topic of post-operative nerve repair immobilization. They discuss key principles, variations in protocols, and practical tips for optimizing outcomes following nerve repair. Tune in to learn how to apply evidence-based reasoning to your post-op management approach.
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Transcript
Introduction: Nerve Repair and Patient Care
00:00:05
josh MacDonald
Hi, I'm Josh McDonald.
00:00:07
Miranda Materi
And I'm Miranda Materi and we are Hand Therapy Academy. So today we're going to be talking about what to do when you have a patient that has a nerve repair, Like how long should you immobilize it? Should you be moving it?
00:00:20
Miranda Materi
Does it depend on the nerve? So answering a lot of those questions. um This is a common question we get around exam time because i think there's such a wide variety in the research. And oftentimes we'll have people that look at different sources or maybe they're doing not just our exam prep, but they're maybe doing another one and there's some conflicting information.
00:00:39
Miranda Materi
So I thought we could start by clearing that up.
Evolving Research and Practices
00:00:42
Miranda Materi
by looking at what the recent research says and why you would do one versus the other.
00:00:48
josh MacDonald
Yeah. Okay. So we get these questions all the time and sometimes it's on the fly and sometimes it's in an email or a DM and it's great because it makes us think it, um you know, we, we fall into patterns of what we've learned to do.
00:01:01
josh MacDonald
And so it makes us like, well, wait a minute, what does the research say about that? And so we look into things and I know what I do clinically and, but what does the research say? Cause I could just be making that up for the person that I learned it from could be making it up.
00:01:11
josh MacDonald
So but what did you find when you did a little bit of research, Marana?
00:01:12
Miranda Materi
Right.
00:01:15
Miranda Materi
Yep. So what I found is that um there older protocols recommend immobilizing the nerve for three to four weeks, but a lot of the newer research shows that it's important to do early protected motion and they don't show any difference in like clinical findings, like the sensory findings remain the same. So there's no basic clinical differences when you immobilize the nerve completely. So you're blocking it, you're not allowing that um nerve to move at all versus doing some protected motion of the nerve. So that doesn't mean the patient comes to you and they're not going to be wearing a brace or anything like that. You're most likely still going to splint them. You're going to just do protected range of motion like we
00:01:56
Miranda Materi
we would write not unrestricted motion. They're not using their hands and carrying blocks or anything like that. We're still, we're teaching them tendon glide. We're teaching them how to protect it. Um, So I think that's like a big difference and a shift for a lot of people.
00:02:09
Miranda Materi
Now there is
Surgeon Preferences vs. Research
00:02:10
Miranda Materi
a caveat to that. I would say a lot of times what we do is directed by the surgeon, right? So a surgeon has his own surgical preferences. So if he tells you to mobilize it for three weeks, of course I will do that because sometimes the nerve could be repaired under tension as well, right? We don't exactly know what was going on in that surgery.
00:02:27
Miranda Materi
Um, so I would always, of course, follow the surgeon's guidelines and, and what they want first. Um, but generally speaking, it is safe to start moving that nerve early. And I think we see this when we're treating flexor tendons a lot too, where they have a tendon involved with the nerve as well.
00:02:44
Miranda Materi
And i when I first started, we would wait three weeks to move that tendon as well. But now we start early. We start around that five-day mark and get them moving. And that's the same. Even if they have a nerve involvement, we do the same thing. We get them moving, and we but we still protect it.
00:03:01
josh MacDonald
Yeah, yeah. And so some of the stuff we hear from other, from some of our members say, hey, I saw in this source, they say three weeks. This one says four, this one says two.
00:03:12
josh MacDonald
So what do you tell someone, let's say specifically for who's prepping for the exam? What answer do we give them that they're most likely to want? Because the exam is not about what's new in the current research. The exam is like when they wrote those questions. So what's your answer to someone when they say, what is the test going to ask me?
00:03:29
Miranda Materi
I think, well, for one, we don't know exactly what that question looks like, right?
00:03:33
josh MacDonald
Right.
00:03:33
Miranda Materi
So i always start with that. Like, I don't know, like, I'm not going to say hard and fast. They need to be immobilized for three weeks. I would tell them to look for details in the question. So does that question say the nerve was repaired under tension, you know, really like look into it or is it saying, um you know, the patient has good healing. They have all
Navigating Conflicting Information
00:03:52
Miranda Materi
the right.
00:03:52
Miranda Materi
um I don't know, like their past medical history supports early motion. Like, look for some of those clues that we're starting to use with our clinical reasoning and some of our clinical thinking.
00:04:04
Miranda Materi
And then I would say, if it comes down to a question, you are going to start range of motion on that sooner than later. You're not going to wait the three to four weeks, because I do think that's an easy one for the exam writers to know is not correct and to update.
00:04:18
josh MacDonald
Yeah.
00:04:19
Miranda Materi
And this research is not like coming out just this last year. It's been out for a while.
00:04:23
josh MacDonald
Yeah.
00:04:23
Miranda Materi
It takes a while, I think, for um some sources to get the new update, right? But I know this has been around for at least the last 10 years, maybe longer.
00:04:33
josh MacDonald
Yeah. And we do get a fair amount of questions from people saying, hey, I read in Rehab of the Hand or I saw in this source or another source information that doesn't always agree with what we're presenting. And we can't speak to other sources. We can't say where they got their information out because we weren't in the process ah the the formation process of their curriculum.
00:04:51
josh MacDonald
um But what we can say is, here's what we found in the research. Definitely go to Google Scholar and do your own research searches or Elsevier or whatever you have access to. But all we can do is say, here's what we found in the research.
Collaboration and Communication in Rehab
00:05:02
josh MacDonald
And you can ask them for their information. And it's entirely possible to have information that is conflicting that is from around the same era. Now, if it's something from 2000 and something from 2018, well, then there's an advance, but we can't really speak to other people's content.
00:05:18
josh MacDonald
content
00:05:19
Miranda Materi
Right. And then what is, i think another thing we think about is what is the consensus in the rehab community? Right.
00:05:25
josh MacDonald
yeah
00:05:25
Miranda Materi
Like, um, and this isn't that scientific, but you're talking to other people around, hey, are you moving nerves early? Or, you know, does your um surgeon want you to hold them? And I would also say we follow suit with what the hand surgery literature says, oftentimes too. So if the hand surgeons are up to date on their literature as well, asking them, it can be very helpful. And and hand surgeons have to do maintenance of their certification. So they're required to stay up to date on um various topics. And so I think asking them is always a very helpful resource as well, especially when it has to do with something that is um based on what was done in the surgical or the operating room.
00:06:06
josh MacDonald
Yeah, yeah. Unfortunately, I do get the answer a lot of times, just do the therapy protocol, right? Like the surgeon's like, ah, just do what you do. and Whatever form their response comes in is just do that.
00:06:19
josh MacDonald
But they're also on the hook for knowing how long we should be immobilizing or how early to be mobilizing. So that's a fair question to ask your surgeon.
00:06:26
Miranda Materi
Right. And if they say just do the protocol, i would say I would follow that up with a question. Hey, how was how did the repair go? You know, how did it look?
00:06:34
josh MacDonald
Yeah.
00:06:35
Miranda Materi
Do you feel, you know, is there conduit? Like I would just ask a few follow up questions. So, you know, like you have confidence in what you're doing. Well, if they say, oh, the repair was great. There's no there's not an an intention. Then, you know, you're probably pretty safe to start moving it.
00:06:47
Miranda Materi
And, you know, you're safe based on what the research says.
00:06:51
josh MacDonald
Yeah, yeah, definitely.
Engagement and Queries
00:06:53
josh MacDonald
All right. So just a quick one today. If you have any questions, feel free to reach out to us, info at handtherapyacademy.com, or you can reach us on our social media platforms, Hand Therapy Academy.