Instructional Concurrent Session 2

Complete care of the patient with upper limb loss mandates a long-term, multifaceted approach. Increased functionality and quality of life require collaborative efforts between the patient’s surgeon, prosthetist, hand therapists, mental health professionals, and peers. Consistent communication and team decision-making shape each patient’s preoperative and postoperative course. We aim to relay effective interventions at each step of recovery from each clinic member and describe clinic workflow designed to reinforce holistic care.

Level: Intermediate

Loss of ulnar intrinsic muscle function correlates with diminished grip strength, pinch strength and dexterity and often results in hand deformity. Nerve transfer surgery is well described in the literature as good surgical option to aid in the restoration of ulnar intrinsic function in the setting of ulnar neuropathy, yet there are some who question the surgery in the setting of inconsistent outcomes. The senior presenter is a world leader in the area of nerve transfer surgery and will present her algorithm for patient selection as a key to understanding the surgery and improving outcomes. A lack of knowledge of comprehensive, post-operative motor re-education programs is also cited as a potential limiting factor to recovery of ulnar intrinsic muscle function. We will review the key concepts of nerve transfer motor re-education relating specifically to the anterior interosseous nerve to ulnar nerve transfer. Instruction in techniques for assessing and advancing exercise programs will be discussed. An outline of appropriate treatment for each of the three phases of recovery will be covered.

Level: Intermediate

There is growing recognition of the pivotal role of mental health in musculoskeletal care, including for patients recovering from an upper extremity injury or surgery as well as for patients with chronic upper extremity conditions. Premorbid mental health diagnoses, symptoms of depression or anxiety, and pain-related beliefs are examples of factors that can be associated with limited adherence, poor outcomes, and underutilization or overutilization of health care services. Assessing and addressing mental health in traditional musculoskeletal care spaces can be challenging because of stigma, lack of clinician knowledge and comfort, and limited access to relevant resources. This session will provide a hand surgeon’s, physiatrist’s, and hand therapist’s perspectives on this topic. Clinical pearls to assess and address mental health in musculoskeletal care will be complemented by research findings and relevant case examples.

Level: Intermediate