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Driving with Upper Extremity Immobilization: A Comprehensive Review
Brinkley K. Sandvall, MD; Jeffrey B. Friedrich, MD
University of Washington, Seattle, WA

Introduction: Driving with upper extremity immobilization is potentially dangerous. The aim of this study is to review current medical literature, state laws, and guidelines on driving with upper extremity immobilization in order to provide a comprehensive, methodical review of the available evidence.
Materials and Methods: A literature search was conducted using MEDLINE to identify all English language citations related to driving with upper extremity immobilization. Potentially relevant articles were identified, and bibliographies of articles were reviewed to capture articles not initially identified. Additionally, a law literature search was completed. LexisNexis, HeinOnline, and Westlaw Classic databases were searched for relevant articles, state statutes, codes, and regulations. Each state's Department of Motor Vehicle handbook was reviewed.
Results: Fourteen studies, three of them conducted in the United States, were reviewed. Five studies with 46 subjects provided subjective and/or objective assessments of upper limb splint immobilization. Of two studies that evaluated only below-elbow immobilization, one found driving in a wrist splint had no perceptible effect on driving ability, and the other supported safe driving under normal (but not hazardous) conditions. All three studies that evaluated both below and above-elbow immobilization recommended against driving with left arm above-elbow immobilization. Two of them found a trend toward worse driving performance in both short and long arm splints. The following societies' policies on driving are: 1) The American Medical Association and the National Highway Traffic Association have a joint recommendation pertaining to older drivers which recommends referral to a rehabilitation specialist for evaluation if concerned, 2) the US Public Health Service recommends normal motor function and adequate mobility of both upper extremities and a performance examination when physically impaired, and 3) the US Department of Transportation recommends a performance evaluation using a trained driving tester to determine fitness of commercialmotor vehicle drivers with musculoskeletal disorders. There are no state statutes or multi-jurisdictional surveys on the topic.
Conclusions: We present a review of the medical and law literature on driving with upper extremity immobilization. This study finds that driving is hindered in some splints, that there are substantial variations in physician practice patterns, that there are no formal guidelines for physicians and patients to consider, and that there is a paucity of published literature on this topic in the United States. We believe both physicians and patients would benefit from evidence-based recommendations or practice guidelines.


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