Ischemic Monomelic Neuropathy Treatment & Management
- Author: Michael T Andary, MD, MS; Chief Editor: Robert H Meier, III, MD more...
Few predictable medical problems are associated with ischemic monomelic neuropathy (IMN). Evaluation by a physiatrist can help in the diagnosis, treatment, and rehabilitation of the condition.
Surgery has little to offer in established IMN. In cases of acute thrombosis or compartment syndrome, surgical intervention may be beneficial.[7, 8] There is at least 1 case of IMN caused by an arteriovenous fistula for dialysis that improved with surgery. The fistula was banded and neurologic function returned; the graft was saved for future use in dialysis.
Inpatient and outpatient care
Inpatient care for patients with IMN is 2-fold. Patients with IMN may have numerous comorbid medical and surgical problems that require monitoring and interventions. If the IMN significantly interferes with wrist/hand or ankle/foot function, physical and occupational therapy services are warranted under the direction of physiatry specialists.
Outpatient care is a continuation of rehabilitation goals and may include functional mobility training, preservation of range of motion (ROM), education with regard to limb care, and pain management. Psychological counseling to assist with adjustment to disability also may be warranted.
Physical and Occupational Therapy
Rehabilitation measures to assist with recovery after IMN depend on the degree of nerve injury. An aggressive and appropriate ROM program can prevent contractures in the involved limb. Thermal agents should be used with caution, given concomitant sensory impairments. For gait activities, a double metal upright or solid plastic ankle-foot orthosis (AFO) may be indicated if there is poor control of ankle and foot movement.
An aggressive and appropriate ROM program, particularly in the hands, can prevent contractures. Working to improve activities of daily living (ADL) is important, and adaptive equipment may be beneficial in aiding independence.
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