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Ischemic Monomelic Neuropathy Treatment & Management

  • Author: Michael T Andary, MD, MS; Chief Editor: Robert H Meier, III, MD  more...
 
Updated: May 13, 2015
 

Approach Considerations

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.[9]

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.

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Physical and Occupational Therapy

Physical 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.

Occupational therapy

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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Contributor Information and Disclosures
Author

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Received honoraria from Allergan for speaking and teaching.

Coauthor(s)

Ryan C O'Connor, DO Consulting Staff, Department of Physical Medicine and Rehabilitation, Sports and Spine Medicine, Lansing Orthopedic, PC

Ryan C O'Connor, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Barinder Singh Mahal, MD, FAAPMR Attending Physician, Norwalk Hospital

Barinder Singh Mahal, MD, FAAPMR is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier, III, MD Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke’s Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier, III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Acknowledgements

Patrick M Foye, MD, FAAPMR, FAAEM  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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