Evaluating Radial Nerves as an Occupational Therapist
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[00:00:00] All right, so we're gonna go on to radial nerves, and I'm just gonna talk about in terms of radial nerves, like radio nerves are, in a way, some of the easiest things to, to work with, or one of the easiest ones to work with because it affects the wrist and the wrist sensors. And the finger sensors, right?
[00:00:23] The great thing about a radio nerve, it really doesn't ne. Fact, the defined motor coordination and strength of the hand, unless you don't position the wrist in a certain extension. We get power in our fingers when you make a fist. If you look at your fist, you naturally have a certain amount of extension, right?
[00:00:46] Having a certain amount of extension allows you to have better power grip, right? It's just the mechanics, kinematics of how the hand and wrists help each other. Now this is, if something happens to someone's wrist, that's why they can't move their fingers as well, [00:01:00] or they might lose a certain amount of strength that they have.
[00:01:03] So if the radio nerve. We have to know where the radial nerve comes from and comes down,
[00:01:16] right? It actually comes down, hits the triceps first. So it hits pretty high and then it wraps around the hum the humeral shaft, right? So let's say here is a humeral shaft and it wraps around here, and then you have the breaker radialis, and it has some some other branches to the skin.
[00:01:39] Okay? We're not gonna talk about that, but it comes in. Break your radialis, right? And then after that it's gonna start going into Theen carpet radius brevis longest, right? Am I doing that right? Yeah. The sup. [00:02:00] Soup. NA is a huge one. These two are like the biggest ones that I tend to look at, and it goes down and I'm not gonna go into all of 'em, but then it goes to the E D C, right?
[00:02:12] There's a bunch of other ones, but really some of the biggest ones that I always look for when I'd see a radial ar when I see a humeral shaft fracture, right? I go and I check triceps. If their tricep works, I know that it's everything below. And then I will check the risk sensor. And most of the time they won't have it.
[00:02:40] So then you're gonna know exactly where. The injury is, and it's not sometimes I was talking to somebody who's if you're getting it straight from the surgeon's office, sometimes you can, you just think, oh, like it is what it is, right? But in reality, we should always be checking in reality.
[00:02:57] I get patients who don't come from, like [00:03:00] directly from a surgeon's office, and I really do need to figure it out. Because you might get the script late, you might never get it. You might not get the op report in time. But I could look at someone and know, okay, it's a humal shaft fracture. So that scar comes right down the arm and we ask them about, scars really do tell you a lot from the injury.
[00:03:22] Now they come in. A lot of times people with are hemal shocked fractures. They're gonna come in, they're gonna lock a certain amount of movement, they're gonna have some tightness in their joints. And so you have to differentiate those type of injuries. Okay, is it a joint problem cause he got stuck, or is it because some of the, they're not moving and that's why he's also stuck.
[00:03:41] So we had a guy who came in, he shaft fracture. One of the first things I do is I check the triceps and I say, okay, is that intact? And they might not move. Fully for you, but what you're doing is you're feeling for some amount of of muscle activity, right? Muscle grade 0, 1, 2, 3, [00:04:00] 4, 5, right? Muscle grade.
[00:04:02] And then usually after that, I'm looking for risk extension as well. So we put someone like this is gravity eliminated, right? For risk extension. So if I have someone laying, most of the time they're gonna come in and this position is the easiest position for them, and you're gonna palpate and you're just gonna say, can they move?
[00:04:19] If they got nothing, then you would put them in a gravity eliminate and try and move it. If they don't have risk extension, then. They're not gonna have any of these other things below it either. So they're not gonna have supination. And what throws people off about the SUP nation is that it's going to look like they have supination and they're going to look like they have supination because the SUP is the strongest supinator muscle, right?
[00:04:50] It's the strongest sup. I'm sorry, what did I say? The sup is the strong, oh, sorry the biceps. The biceps is the strongest souper. So you're gonna see them, [00:05:00] be able to do a certain amount of supination once you initiate them, right? That's how you're going to determine at what level it's impaired and how bad is it.
[00:05:11] Now, radial nerve injuries have the potential to fully recover depending on. The type of injury Now I've worked with I had a guy who, he was hit in a hit and run the car, hit him, and projected him into a concrete pole. He sustained a ton of injuries and one of his injuries was a hero shaft fracture, and he was unconscious and in a coma for several months.
[00:05:39] So of course they fix it. But they couldn't really do anything. They appear in a coma, so when he came out after that surgery and they tried to get him moving, once he woke up, that's when they realized, oh, something happened. To his wrist because he just had no wrist extension and no [00:06:00] finger extension.
[00:06:01] So his, he could probably use his hands like this, right? So once they started moving his off, so already we know, okay, so here, majority of the time, it's either a traction injury or it's a compression injury, right? A compression injury because he, maybe he swelled up too much right at the injury.
[00:06:28] And that would happen essentially right at the moment that it happened, or it could be a traction injury, which because of where. The fracture is, and that nerve is wrapped around even as careful as it could be there's going to be a certain amount of traction injury pulling while they fix it or while they're getting ready to fix him, right?
[00:06:50] Hey, therapy friends, it's Wong here. Thanks again for watching my video, and if you like videos like this, I can help you just crush it in the hand therapy world as an occupational therapist. Then hit [00:07:00] the subscribe button and enjoy the video. Thanks again for watching.
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[00:07:54] Thanks. See you on the next episode.
