Therapeutic exercise based on biobehavioral approach for the rehabilitation of a radial nerve injury after surgical removal of a schwannoma : a case report

Abstract

Schwannoma is a benign tumor located in the Schwann cells of the nerves. A 36-year-old white man underwent surgery after being diag-nosed with radial nerve schwannoma of the upper right extremity be-tween the triceps brachii muscle and brachioradialis muscle, after which a complete axonotmesis of the aforementioned nerve trunk oc-curred. The symptomatology presented by the patient included a loss of both motor and sensory function of the fingers, hand, and right forearm. The treatment was a biobehavioral physiotherapy approach that includ-ed therapeutic exercise, neuro-orthopedic manual physical therapy, therapeutic education, and sensitivity retraining. The biobehavioral ap-proach in physiotherapy includes a multimodal approach that encom-passes biological aspects, along with cognitive-evaluating and motiva-tional-affective components. Two weekly sessions were held for 6 months, resulting in a total of 48 sessions. Using multimodal physiother-apy based on a biobehavioral approach, after 6 months of treatment, the symptoms improved. The motor function of the upper limb improved considerably due to the recovery of increased activity of the superficial musculature dependent on the radial nerve. However, the functions de-pendent on deep forearm and hand musculature recovered to a lesser extent. At the sensory level, the retraining of sensitivity allowed the pa-tient to regain an important sensitivity. This case report explains the treatment used and the findings obtained, given a large percentage of the functionality that had been lost was recovered.