LSUHSC Occupational Therapy Brachial Artery Treatment Protocol

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LSUHSC Occupational TherapyBrachial Artery
Treatment Protocol
Carla Saulsbery LOTR,CHT Dr. A. Hollister MD
Grays Anatomy
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• Brachial Artery has three main branches. The
  profunda brachi is the first and
• most important
• Below the antecubital fossa it branches into
  the radial and ulnar artery
• Commonly injured from both penetrating and
  blunt trauma usually associated
• with humeral fractures. At greatest risk in
  proximal one- third, where it
• lies next to the humeral shaft, and in the
  distal one-third near the elbow.
• After cardiac catheterization 1.5 of patients
  require thrombectomy
• Repair by end to end anastomosis or saphenous
  vein graft
• Any hematoma may compress the brachial artery
  or median nerve in the
• antecubital fossa and result in ischemia or
  neuropathy or both
• The greatest amount of healing in the vascular
  system occurs within the first
• four weeks.
• Healing of the endothelial lining occurs within
  the first 2 weeks.
• Remobilization is initiated after endothelial
  healing has occurred.
• Injury to the brachial artery will cause
  radiating pain, decreased skin
• temperature, decreased pulses and pallor of
  the distal arm and may result
• in Volkmann contracture

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• Precautions
• Follow precautions identified from the surgeon
  regarding specifics of the
• vessel repair
• Extremes in temperature which could cause
  vascular spasm.
• Arterial spasm can lead to ischemia
• Avoid excessive external compression from
  dressing splints, etc.
• Therapy is not indicated when there is
  thrombosis or vessel integrity
• is in question.
• Pain from vigorous exercise may precipitate
  vasospasm
• Activity or splints should not decrease digital
  temperature.
• When removing dressing avoid trauma to the soft
  tissues which could lead
• to vascular spasm.
• Arterial insufficiency digits will turn white
  or pale in color.

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• Postoperative Therapy
• 0-2 weeks
• Elevation of the extremity. Flex elbow 60-90.
  Begin elbow flexion exercises. Keep arm in sling
  or fabricate LA splint
• Splint to the hand and wrist as needed to
  decrease edema, preserve the arches of hand.
  Preserve ligament length
• AROM exercises to the shoulder and hand
• Patient education in avoidance of caffeine,
  temperature extremes
• Watch for signs of vascular compromise-may
  include increase edema,
• decreased temperature, or increased pain.
• 3 weeks post op
• Gentle AROM exercises to the elbow and wrist in
  extension and flexion
• Baseline sensory and motor exam of median nerve
  as indicated
• Address joint tightness, soft tissue tightness
  adhesion prevention,
• sensory dysfunction
• 5 weeks post op
• Once vascularity is stabilized light compression
  can be started
• Retrograde massage

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• Weeks 6-8
• Light functional activities
• Pressure garments if no signs of infection or
  vascular instability
• Scar management
• Weeks 8-10
• Light resistive and progressive strengthening as
  tolerated
• Sensory re-education as indicated