VEST RESTRAINT PALSY

Objective: Evaluate by electrophysiologic methods the cause of arm wea kness and numbness in an agitated patient who struggled against a vest restraint garment. Case Presentation: An agitated patient with enceph alitis required vest restraint and developed bilateral numbness of han ds and weakness of distal upper extremity muscles. He was of thin stat ure and had abrasions in the axilla from the restraint straps. Routine nerve conduction and needle electromyographic needle studies were use d to document bilateral conduction block of ulnar and median nerves be tween the elbow and Erb's point with minimal denervation. Intervention : After identification of the vest restraint as the cause of neuroprax ic palsies, adjustments were made to the vest straps. Results: The sym ptoms and clinical signs began to resolve with adjustment of the vest restraint straps and completely resolved after the patient was no long er encephalopathic and was discharged from the hospital. Conclusions: Compressive nerve lesions in the axilla should be recognized as a pote ntial complication of vest restraint, especially in combative patients . (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.