Understand nerve injuries and provide better treatments
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[00:00:00] As an occupational therapist, you might be working with lots of various types of nerve injuries. Now specifically, I'm going to talk a little bit about nerve compressions, but if you think about it, all of our nerves come out of one place, and we could be working with people with hand and arm injuries that have nerve compression issues.
We could have, um, okay, so there's three types of nerve injuries, right? There's compression, traction, and lacerations. So when it comes to nerves, you can, you can work all those things, but first it requires you to understand what are the nerves and what do they do? Right? And so, um, if we think about it, this is your brain, right?
This is your brain on drugs, right? And here is, your neck, right? And out of your neck comes these nerves. And okay, so we're going to call this [00:01:00] the cervical cervical spine. And then from there is of course, your thoracic spine that then sits on top of your lumbar spine. All right, I'm just going to Abbreviated like that.
So what happens here when we as an occupational therapist, when we tend to work with various types of injuries, um, all of the nerves essentially come out of the neck and they move down the arm, right? So in this particular, you have your. You have your, um, your cervical, right? And then pretty much like this chunk right here is your brachial plexus that then becomes what we call your terminal branches.
And yes, everyone thinks, Oh my God, I have to know the brachial plexus. You actually don't need to know it in detail unless you are studying for the CHT [00:02:00] exam, right? For the most part, if you have a book, You're allowed to go and look in it, right? And this is one of the reasons why I always recommend the rehab of the hand as a great resource to have and to keep for you to look through.
Yes, you can go on the internet and you can find stuff, but sometimes it's really nice to have a book that you can like solidly go to and get the specific information that you need based on what you're looking for. Now, like I said, we're working with, we work with nerves, we can work with compression injuries.
We can work with traction injuries and we can work with laceration types of injuries now majority of us That's not necessary. I was going to say majority of us work with Compression issues that are very chronic in nature, right? So this is our chronic type of injury and then here our [00:03:00] traction or laceration These are considered acute types of injuries because you don't just cut a nerve.
You don't just pull on a nerve. Something has to happen in order for something like that to happen, right? And so from an acute injury, it can then become a chronic. And if you think about the journey of a patient, the journey of a patient can come to you for many different reasons and many different ways.
But all along the way here's your shoulder, right? So we're going to say shoulder. Um, then we have your elbow that we always have to look at. And then of course, down here is going to be your wrist and hands, right? And so when you think about this, this is the pathway the nerve. Like I didn't make this up.
We were created this way. All right. So if you think about nerve injuries, we think about all of those, and these are considered [00:04:00] peripheral nerve injuries. Now, of course, here is your brain. Right? Did I spell that right? Brain. Oh, I'm a very bad speller. Brain. I always have to write it twice. Right? This is your brain and what happens when you have a peripheral nerve injury presents itself one way and then when you have a central nervous system injury, which is called a stroke, there's other various.
I'm going to talk a little bit about stroke and how it affects the brain and how it impacts the nervous system. So stroke is one of these neurological, like, uh, central nervous system types of injury. But stroke is one major one, right? And so what happens is the injuries to the brain, and then it's going to affect the arm in a different way.
But these are all different types of nervous system or, uh, neurological types of injuries. [00:05:00] In hand therapy, very specifically, what, uh, Most CHTs are known for are peripheral nerve injuries. And what I'm hoping to over time as I share more and more information is to have more occupational therapists feel more comfortable working with all types of stroke all the way down through the arm.
And you don't have to say, Oh, I'm not a hand therapist. Uh, I think you should be right. I think you should be, uh, maybe that's just opinion, but you don't have to be a certified hand therapist to know how the whole arm is supposed to work. Because one of the things as an occupational therapist that we have the capacity to do is essentially break down your activity and break down the things that are required for you to need in order to do the activity.
And when we break that down into the need, we break that down from an anatomy standpoint. Let me know if [00:06:00] that makes sense. Leave me a comment below, you know, what questions you have from what I've already discussed. Now inside the mentorship program, we're going to be diving much deeper into nerve compression types of injuries because I want to help you be able to clinically think through not just the anatomy portion because everyone gets stuck on the anatomy, but here's what happens.
that there is a disconnection between the anatomy and then how you apply the anatomy. Because all along the way, you should be able to look, you should be able to do clinical testing, and you should be able to make a determination in terms of what is the appropriate treatment to provide. If someone needs a splint, what is the appropriate treatment?
type of split that this person needs. What is the prognosis? Like what? What are the likelihood that they're going to recover right? And how much are they're going to recover? Because you know what? At the end of the day, patients are going to ask you over and over, over again, like [00:07:00] What's going to happen to me?
How's my arm going to get better? When is this going to get better? Is this ever going to get better? Let me know if your patients are not asking you those questions. Cause you know what? They're asking me those types of questions. If I have an X, Y, Z problem, when is that going to get better? If I have a, you know, if I do surgery, Am I going to get better?
Right? So I think as occupational therapist, if you're working with anyone with a hand and arm, you should know the answers to this. And maybe I shouldn't say it should, uh, but you have the capacity to learn what that is and what you can do for it. Cause how you treat a central nervous system and how you treat a peripheral nervous system.
nervous system. There are some differences, but there's a lot of overlap in terms of, you know, what you can do to provide that treatment, whether it be range of motion, facilitation of a muscle, you know, um, getting strength back, what kind of split recommendations there are. I think that there's a lot [00:08:00] that, um, you can do in order to help regardless of whether they are a chronic type of issue.
or an acute type of issue that then also, you know, becomes chronic, right? And if I, I want to encourage you to also think about like the, the anatomy of the nerve itself, right? And so unless you're, again, unless you're studying to become a certified hand therapist, you don't need to know all of the, you know, the bundle and in the, uh, uh, inside the bundle, inside the bundle.
And you don't have to know all the different types of, um, divisions of the nerve, One of the most important concepts I think that I could share with you in this video is the idea that you know what a nerve really is. The nerve provides power to the muscles, right? And then of course anything that happens then gets fed up through the nervous system into the brain so the brain can like interpret the information, right?
But if you think [00:09:00] about, if you think about your bone, right? Let's think about this is, this is a P1. The proximal phalanx, middle phalanx, and distal phalanx. So this is P1, P2, P3. The three phalanxes allow your fingers to be able to extend, to be able to, give your fingers a structure to be able to flex and extend, right?
It's one piece. And then if you think about what moves your MP joint, your PIP joint, your DIP joint, are the muscles that cross it. So in order for you to flex, Right. The eyepiece, you have to have a superficialis and a profundus that actually starts in the elbow, crosses the wrist, crosses the fingers, and wherever it inserts, it's the primary mover.
And so it goes into flexion and then you have your extensors and then help you to go into extension, right? Each has one component and one piece. And we have a tendency to think of bones and [00:10:00] muscles and ligaments as pieces, right? I think the main difference when it comes to nerves is it's actually not in pieces.
It's actually one continuous piece that then branches off into different, um, like different compartments. If you can think about it, If I have a ponytail, right, all my hairs are tied together as a ponytail. If you pull on me, no matter what part of the ponytail, you're still pulling on one big long structure, right?
It's one continuous long structure with different aspects and different components, and the different aspects and different components are going to, um, give different symptoms, right? So if I pull on one little piece, it might feel differently than if I pull on the whole piece. A different kind of way, right?
So essentially like [00:11:00] that's my analogy, but really it's one continuous piece. So where your skill as occupational therapist comes in is Is to be able to evaluate and what I consider like critical thinking, um, thinking forward and backwards, right? So let's say you find something at the elbow level, right?
So what are the structures of elbow level that can cause? these types of problems and then say, okay, well, well, what do I know about nerves? Nerves, wherever they're injured, they're not, you don't feel it there. You feel everything distal, right? It's different, like a phalanx. If you, if you, if you jam the finger at the PIP level, you feel it at the PIP level, don't you?
Right? If you break it, it's at the PIP level. In nerves, you jam it, you break it. It's not there. You feel everything distal to where it is, right? And so that's a, that's a second really [00:12:00] important concept when it comes to nerves. So we're gonna dive more into nerve injuries inside the mentorship program where we go into Not just the anatomy of it, but, um, in a way that helps occupational therapists understand, like, what are the clinical tests that I need to run?
What are the things that I need to consider so I can help someone with carpal tunnel with cubital tunnel? And how do I differentiate? Lateral condylitis from radial tunnel, right? So all those structures are there around the elbow and the hand. But you know what? The most amazing thing about the nerves is it doesn't stop there.
It actually so much is related to the shoulder. And then how do we differentiate the shoulder from the neck issues? Right? And so, um, that's why I, I'm such a believer in like, don't, when you're treating nerve injuries. You know, when you're treating [00:13:00] anything arm and hand related, don't just stop at the hand, right?
I used to do this, and this is why I guess I'm so passionate about nerve injuries, because when I first started in outpatient, I thought carpal tunnel was at the hand and at the wrist level, and I would only do these like, you know, nerve glides right there at the hand and at the wrist level. But like I said, It's all interconnected.
It's one long, continuous piece. And so, I think if you want to be able to find, I think if you want to have better results for the patients that you're working with, um, you're gonna need to know how to dive into Is it a neck issue? Is it a shoulder issue? You know, where is it stuck and what is, you know, what's getting it stuck?
Is it a joint issue? Are the other muscles out of balance? Are the [00:14:00] ligaments too tight? I mean, there's got to be something. It just doesn't just happen. Right? Especially if you're chronic. Now, if you know, from an acute standpoint, dude, I cut my tendon, you know, I mean, I cut my nerve, right? So then, you know, at that point, but then everything acute will become a chronic.
over a period of time. So you have to learn how to critically think through and move all those things. And that's what we go and do inside the mentorship program. So if you're interested in learning more about nerve compression types of injuries, um, nerve laceration, traction types of injuries, and really at the end of the day, how to effectively help and get your patients results, right?
If you want to, you know, if you're treating and you don't know what splits how to recommend, [00:15:00] you know, I don't know about you, but like, I think about those past cases. I'm like, Oh, my God, I wish if I could go back and help those people, they would think that therapy actually works, you know, because so many so much of the time, I thought that, Oh, you just have to do surgery because when I was working at the hospital, that was all I was fed.
Oh, just do surgery, just do surgery. Right. And even when you study for the CHT exam, it's just like, Oh, they have surgery. You know, what I found is working in private practice. There are so many more people who just live in pain who they're not even candidates for surgery, right? They have to get so bad in order to have surgery.
And some people, like I said, some people are not candidates for surgery because there's not a surgery to fix everything. And wouldn't it be nice? Wouldn't it be really nice for you as an occupational therapist to be able to help your patients get better [00:16:00] results? Like, I don't know about you, but if It certainly makes me feel really good when I'm able to help my patients get results.
And if they're telling me, Hey, Huang, I want to avoid having surgery. I'm like, based off of what I know about their story, what I know about what they've done or what's worked and what hasn't worked. I'm actually able to get results for them and help them like get out of pain, be more active, you know, be able to work without pain, be able to sleep without pain, be able to wake up without pain.
Um, but it requires our ability to, uh, properly evaluate someone and then provide the technical skills, the technical treatments, and it can be exercise based. It could be, um, manual therapy based. It could be a little bit mixture of both, right? Usually those can be really nice. Uh, a little bit of a mixture of both some hands on treatment, some, some exercises.
There's a lot of modalities that you could try that can help, but really so much of what you decide to try all comes from your ability to problem solve [00:17:00] and critically think through what to do and what treatments to provide that really get you results. Anyway. If you're interested in learning more about nerves and nerve injuries and how to get great results for your patients I'm actually diving into nerves in the month of June inside the Mentorship Program and I'm gonna include the link below for you to Just take a look at what the Mentorship Program is really about and see if it's a good fit for you If you like this explanation Make Click the like and subscribe to Hand Therapy Singers and let me know in the comments below if you have any follow up questions Because this is how I know what kind of videos you need to see next.
Thanks for watching until next time. I'll talk to you soon
