Skip to main content
Physiatry '24 Main banner
Final Program


Final Program
Back

Electrodiagnostic / Neuromuscular Medicine

Poster Gallery

306 - Palm Pressure Induced by Postoperative Shoulder Splint Resulting in Hand Median and Ulnar Neuropathy

Thursday, February 22, 2024
5:00 PM – 6:30 PM EDT
Case Diagnosis: Ulnar and median motor neuropathy secondary to postoperative orthotic use.

Case Description: A 55-year-old female with no contributory past medical history presented to EMG clinic with right hand weakness and paresthesias seven weeks after arthroscopic right rotator cuff repair with regional anesthesia. Postoperatively, she wore a shoulder abduction splint with a hand stress ball. After four days of constant wear, she developed a stage two pressure injury on the proximal palmar surface of her right hand. She was referred for EDX testing because of persistent intrinsic muscular weakness and numbness in the hand. EDX data included reduced amplitude of right ulnar SNAP, decreased amplitudes of ulnar and median CMAPs across the wrist. Needle EMG illustrated positive sharp waves/fibrillations of the APB, FDI, and ADM. Comprehensive root EMG screen including paraspinals of involved extremities were normal.

Discussions: These findings indicate severe axonal ulnar and recurrent median neuropathy in the right hand. Following rotator cuff repair, joint immobilization is recommended for appropriate tendon healing. Commonly prescribed shoulder abduction splints have a palm stress ball feature designed to stimulate circulation and improve healing however this ball can cause increased pressure in the palm if not positioned correctly. We hypothesize that prolonged pressure in the hand from the palmar stress ball resulted in potentially disabling nerve injuries in this case.

Conclusions: To our knowledge, this is the first reported case of a postoperative orthotic-induced pressure injury with associated ulnar and recurrent median neuropathies in the hand. Additionally we propose that the stress ball caused the neuropathies. Clear instructions regarding proper orthotic positioning, pressure relief, and frequent skin checks should be discussed with patients when prescribing a shoulder orthotic with palm stress ball to reduce nerve injury risk.