Acupuncture Treatment of Compression Neuropathy of the Radial Nerve: A Single Case Report of "Saturday Night Palsy"

Developmental and biomechanical considerations in the provision of wrist orthoses in children with obstetrical brachial plexus palsy

Introduction

Children with obstetrical brachial plexus palsy may have motor deficits in wrist extension that impact optimal hand function. Wrist orthoses are recommended for such impairment to address biomechanical and functional needs. The functional need of the child should be considered within the context of their developmental expectation.

Methods

A review of the literature pertaining to brachial plexus, wrist joint and injuries, orthotics devices and splints in children was conducted. The databases MEDLINE, AMED (Allied and Complementary Medicine) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched from 1950, 1985 and 1981, respectively, to July 2009 using the Medical Subject Headings (MeSH) brachial plexus, wrist joint and injuries, orthotics devices and splints under the limits of children aged 0–18 years.

Results

There is a paucity of literature on the orthotic management for this impairment. Therefore, an evaluation of the literature on development and the biomechanics of the wrist joint is necessary to develop clinical guidelines for the provision of wrist orthoses in children with obstetrical brachial plexus palsy. An algorithm for providing wrist orthoses in this population is proposed.

Discussion

A balance between biomechanical risks and functional needs at each developmental stage is needed to optimize hand function in the prescription of wrist orthoses.

Clinical relevance of neuromuscular findings and abnormal movement patterns: a comparison between focal hand dystonia and upper extremity entrapment neuropathies

NARRATIVE REVIEW: Patients with focal hand dystonia and upper extremity entrapment neuropathies may present with similar symptoms and risk factors making it difficult to distinguish between the two diagnoses. Evaluating for the presence of neuromuscular findings and abnormal movement patterns can help assist the hand therapist in identifying the presence of focal hand dystonia or peripheral motor axon involvement in the absence of pronounced muscle atrophy. The purposes of this review article are twofold. First, to describe selected neuromuscular signs and symptoms characteristic of patients presenting with repetitive overuse syndromes of the upper limb leading to either a nerve entrapment syndrome or a focal hand dystonia. The selected topics will be limited to an overview of ectopic neuronal activity with an emphasis on fasciculations, muscle spasms/cramps, and sensation (including pain). Second, the article will conclude with a brief synopsis of focal hand dystonia and compression neuropathies, highlighting general assessment and treatment principles.