Establishing functional outcomes of tendon transfers and occupational therapy intervention following radial nerve injury

Abstract

Upper limb injury, involving radial nerve injury, is a devastating injury, which has significant implications on daily functioning of individuals. Tendon transfers following failed radial nerve regeneration further pose a major challenge for the occupational therapists during rehabilitation. There are various studies globally regarding peripheral nerve injuries and tendon transfers; however, the researcher noted a paucity of literature that described the occupational therapy intervention and measured functional outcomes after completing rehabilitation. The aim of this study was to establish the functional outcomes of patients who underwent tendon transfers for a radial nerve injury and completed the prescribed eight-week Gauteng Provincial occupational therapy hands treatment programme. This study adopted a quantitative, retrospective, descriptive, cross-sectional design. The study took place in the northern Gauteng region of South Africa at Steve Biko Academic Hospital. There were 23 participants identified based on the orthopaedic upper limb outpatient clinic roster; however, only 15 participants were able to attend the physical evaluation of the hand, eight were unable to attend due to the national COVID 19 pandemic. Data was collected by all participants completed the dermographics questionnaire and the DASH questionnaire. Only 15 participants were physically measured in their range of motion of the wrist extension, metacarpophalangeal joints of finger extension and thumb in extension/abduction was measured with a manual goniometer, and muscle strength of the wrist, fingers and thumb was measured using the Oxford Standard Scale. Hospital records were reviewed for passive range of motion of the wrist and evaluating compliance to treatment. The results showed that 69.56% of participants were considered independent when performing their activities of daily living and asymptomatic, while 21.73% were also independent, however had limitations with tasks requiring 22-45kg occasionally or 11-22.72 frequently. Participants’ range of motion fell within functional ranges of the wrist fell within good to excellent category, fingers and thumb between good to excellent category. Muscle strength was between 3 and 4+ by 86.95% of participants, indicating functional strength to engage in activities of daily living. There were factors that hindered participant’s ability to return to work. Reportedly, the majority of employers did not follow the guidelines as promulgated in the Labour Relations act. This compromised many of employees, some even losing their jobs due their injuries. Conclusion: Although there was no achieving of this confidence level in any of the measured outcomes, there were satisfactory to good results achieved from the Dash questionnaire, range of motion of the wrist extension, fingers MPJ extension and thumb MCP extension. The results were good with muscle strength of the wrist extension, fingers MPJ extension and thumb extension.