Interventions for Peripheral Nerve Conditions

Acute Stage

Immobilization and interventions for controlling inflammation and reducing swelling is the primary focus. Gentle AROM in unaffected areas and in pain-free ranges to help maintain nerve mobility above and below the injury is introduced. Care is taken to avoid positions and motions that increase nerve symptoms (pain and sensory changes). Close monitoring of skin for lesions, such as blisters to rule out possible infectious or systemic sources of nerve function loss.

Wrist and hand conditions: Avoid hot, cold or sharp objects; Do not prolong grasp positions, change hands frequently; Utilize built up handles to distribute pressure

Lower extremity conditions: Wear well fitting, protective shoes, have closed toes and heels; Inspect feet daily for signs of pressure or abrasion; Do not walk barefoot; Frequently shift weight during all standing activities

Recovery stage 

The nerve is demonstrating recovery through increasing sensory activity or muscle activity. Motor retraining begins with isometrics in shortened positions and electrical stimulation to promote motor recovery is introduced.

Desensitization may be used by application of various sensory inputs to the affected area, such as placing soft and rough textures on the affected skin.

Discrimination retraining may be used to reteach differentiating 2 points of simultaneous contact. Begin with visual input, then remove it.

Persistent/chronic stage

Interventions are largely compensatory, such as using assistive devices, alternative movement strategies, activity modification, and patient education in activities that may increase strain to the nerve. Interventions for these more complex conditions are addressed in PTA 204/204L; may include interventions, such as the use of a mirror box or guided imagery for pain management and sensory reorganization.