Driving with upper extremity immobilization: a comprehensive review

Driving with upper extremity immobilization can be potentially dangerous. The aim of this article is to review current medical literature, state laws, and guidelines on driving with upper extremity immobilization and appraise the available evidence. A literature search was conducted to identify citations related to driving with upper extremity immobilization and included a law literature search. Each state's Department of Motor Vehicle handbook was reviewed. Fourteen studies were reviewed and 5 provided subjective and/or objective assessments of upper limb immobilization. Of 2 studies that evaluated only below-elbow immobilization, 1 found driving in a wrist splint had no perceptible effect on driving ability, and the other supported safe driving under normal conditions. The 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 below- and above-elbow splints. The following organizations' policies on driving are (1) The American Medical Association and National Highway Traffic Association have a joint recommendation for older drivers recommending referral to a rehabilitation specialist, (2) the U.S. Public Health Service recommends normal motor function and adequate mobility of both upper extremities and a performance examination when impaired, and (3) the U.S. Department of Transportation recommends a performance evaluation to determine fitness of commercial motor vehicle drivers. There are no state statutes or multijurisdictional surveys on the topic. This review finds that driving is hindered in some splints, there are substantial variations in physician practice patterns, there are no formal guidelines for physicians and patients to consider, and there is a paucity of published literature on this topic in the United States. Both physicians and patients would benefit from evidence-based recommendations or practice guidelines.