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Radial Nerve Palsy Expectations: Influence of Initial Assessment and Early Care
Adam Liebendorfer, MA, MSCI1; Nirmala Shivakumar, MD1; Mackinnon Susan, MD, FRCS(C), FACS2; Wilson Z Ray, MD3; David M Brogan, MD, MSc3; Christopher J Dy, MD?
1Washington University in St. Louis, St. Louis, MO; 2Biomedical Engineering, Washington University in Saint Louis, Saint Louis, MO; 3Washington University School of Medicine, St. Louis, MO

Background: There is continued variability in the management of radial nerve injuries, with a lack of consensus as to indications for, timing of and type of surgery to offer. While the decision-making process is often led by the surgeon, patients must weigh a complicated set of advantages and disadvantages for each form of treatment in the context of their own lives. We conducted a qualitative interview study with patients treated for radial nerve injury to characterize the factors they consider during the decision-making process.
Methods: We recruited participants with radial nerve palsies who were managed non-operatively or received tendon or nerve transfers to restore function. Semi-structured interviews were conducted to understand how they and their surgeon arrived at the decision for treatment. We sequentially coded interview transcripts and identified recurring themes that pertained to the study question.
Results: 15 subjects were enrolled (5 each for non-operative treatment, tendon transfers only, and nerve transfers). Participants stated their primary concern was returning to work (n=5), appearance (n=5), regaining motion (n=3), resuming activities of daily living (n=2), and enjoying hobbies (n=2). A prolonged journey to diagnosis (n=2) and prolonged process of insurance coverage (n=1) led 3 participants to change their treatment plan from nerve transfers to tendon transfer alone. Perception of the providers who initially treated the radial nerve injury, positive or negative, heavily influenced how patients viewed the remaining care experience, including with the nerve surgeon. Relaying information when patients felt that they were not prepared to receive it (early morning, n=3, subjective impairment from pain medication, n=3) was a common theme for participants who stated their initial providers did not fully explain their nerve injury to them. The hand therapist was the primary care team member who helped shape expectations (n=13) and provided encouragement (n=10), Participants valued witnessing discussion among members of the care team (n=4) regarding treatment, provided that medical terminology was explained by the end of the clinic visit.
Conclusions: Our findings show the influence that the initial assessment and early care (health care providers seeing patients before the nerve surgeon) has in setting expectations for treatment of radial nerve injuries. Most participants cited returning to work and appearance of the injured arm as their primary concerns. Hand therapists were the primary source of support and information for patients during recovery, affirming the importance of interdisciplinary collaboration and communication.


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