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Injury of Radial Nerve

Medically reviewed by Sandeep Dhanyamraju

What is Radial Nerve?

The radial nerve is one of the branches of the brachial plexus; it “bends” the arm in the spinal canal and controls many motor functions and tactile sensitivity of the shoulder, forearm, and hands.

Various lesions, united by the concept of “neuropathy of the radial nerve“, differ in a specific clinical picture and are an urgent problem for several branches of medicine – neurology, orthopedics, microsurgery, and traumatology – as they occur more often than any other type of nervous pathology of the upper extremities.

The nerve contains:

  • motor fibers, which are liable for the muscles that extend the elbow joint, wrist joint, and finger joints
  • sensory fibers, which are liable for the perception of sensations by the skin receptors on the outer and dorsal surfaces of the limb.

With damage to the nerve, depending on the level of injury, muscle control falls out, and certain areas of the skin cease to feel. The result is paralysis of the extensor muscles, which manifests itself in the typical lowered position of the hand. The patient cannot straighten the hand and fingers. The most common causes of damage to the nerve are injuries, fractures of the humerus or forearm bones, and tunnel syndromes (pinching). Find out more about radial nerve in our article.

History and Physics of Radial Nerve Neuropathy

The “anatomical snuffbox” area is a special zone of the radial nerve innervation on the hand. At the level of the elbow joint, the nerve divides into the sensory branch and the posterior interosseous nerve, which provides motor innervation in the forearm. Therefore, only the motor or sensory function of the nerve can fall out from the level of the elbow joint.

1. Closed damage to the ulnar nerve is considered to be its dislocation due to the internal epicondyle of the shoulder:

  • patients complain of an unpleasant clicking sensation arising from flexion of the elbow joint, accompanied by paresthesia in the zone of innervation of the radial nerve distal to the elbow joint;
  • when the forearm is bent, an elastic cord is palpated, jumping over the internal epicondyle. These patients need a doctor’s advice.

2. Fresh damage to the ulnar nerve at the level above the elbow joint is accompanied:

  • by loss of flexion of the distal phalanges of the 4th and 5th fingers, dilution of 2-5 fingers, and adduction of 1 finger;
  • by sensitivity on the entire palmar surface of the 5th and ulnar half of the 4th finger;
  • on the hand back, the ulnar nerve innervates the ulnar half of the 3rd and 4th to 5th fingers;
  • by damage in the distal half of the forearm, which does not interfere with the flexion of the distal phalanges of the 4th to 5th fingers; 

3. Damage to the median nerve above the elbow joint is accompanied: 

  • by loss of pronation of the forearm, flexion of the hand, and 1-3 fingers, as opposed to 1 finger;
  • by the disappearance of sensitivity on the palmar and dorsal surfaces of 1-3 fingers and the radial half of the palmar surface of the 4th finger.

4. Damage to the nerve in the distal parts of the forearm. Here, it is close to the skin, and it is often damaged, leading to sensory impairment.

Causes, Symptoms, and Diagnostics of Radial Nerve Damage 

Symptoms of Radial Nerve Damage

To cure this disease, you first need to know the reasons, symptoms, and diagnostics.

Causes

“Sleep paralysis” or “paralysis of Saturday night” are synonyms for “radial nerve neuropathy”(RNN) associated with some of the common causes of its occurrence; this refers to the pose of a heavily drunk or tired person who fell asleep in a chair with their hand hanging down. In this position, the nerve undergoes prolonged compression, which becomes an etiopathogenetic factor; similarly, neuropathy of the nerve develops with prolonged use of crutches. With prolonged pressure on a nerve, its myelin sheath can be destroyed, and in more severe cases, axons – long conductive processes of nerve cells (neurons) – are damaged.

Common causes of damage to the radial nerve include fractures of the humerus, too tight and prolonged application of a hemostatic tourniquet, infectious and inflammatory processes, severe intoxication (lead compounds, alcohol, etc.).

Symptoms

The main symptoms of damage:

  • “falling”, hanging wrist;
  • debility when extending/flexing the hand;
  • palm, fingers, forearm, shoulder numbness;
  • tingling sensation, burning on the back of the hand;
  • weakness when abducting the thumb.

With prolonged development of the disease and an increase in the degree of nerve damage, patients often experience a significant loss of motor functions of the upper limb, up to paralysis.

Diagnostics

Dysfunction can be suspected during a detailed examination of the patient. An additional examination method, ENMG (electroneuromyography), is performed – a study of electrical conduction along the nerve. Ultrasound of the nerve is helpful; it shows anatomical changes in the nerve (rupture, swelling, defect, compression, etc.).

Diagnostics of Radial Nerve Damage 

Treatment and Consequences of Radial Nerve Damage 

 When your illness has been diagnosed, you need to start immediate treatment.

Treatment

In case of damage, the affected limb is immobilized, any physical activity is limited, and it is a high probability of brain disorders. Doctors may prescribe non-steroidal anti-inflammatory drugs, diuretics to relieve puffiness, pain relievers, vitamin complexes, physiotherapy, and massage, only by prescription and under the supervision of a doctor. In some cases, hormone therapy is used.

With persisting nerve compression, the ineffectiveness of conservative treatment, and the timing of the cause of the lesion, for example, a recent fracture, microsurgical surgery on the radial nerve may be necessary. It is needed to observe the state for several months; if functional consistency of the limb is not insufficiently effective, an orthopedic operation is performed.

Consequences of Neuropathy

If a long time has passed after the injury, and the neuropathy is untreated, there is a risk of developing neurogenic contracture of the hand. In this case, the compressed and finally affected nerve no longer performs its functions and ceases to innervate the muscles. This occurrence leads to irreversible functional changes – muscle contracture (stable limitation in flexion and extension, persistent decrease in muscle extensibility). Such complications can be eliminated only with the help of separate operations associated with the transposition of tendons and muscles.

Prevention

You can prevent nerve injury by avoiding sustained pressure on your shoulder. Avoid repetitive movements or being in a confined position while sitting or sleeping. If you are doing work that requires repetitive movement, take steps to protect yourself by taking breaks and switching between tasks that require different activities.

treatment of radial nerve damage 

Recovery and Conclusion of Radial Nerve Damage

Recovery is just as important as treatment. Therefore, it is essential to know how long it will last and follow all the rules.

Recovery Time and Prospects

The long-term prognosis of radial nerve injury varies greatly depending on the cause and severity of the injury. In most cases, complete recovery is possible. First-line treatments usually heal most nerve injuries within 12 weeks. If nerve damage is the result of diabetes or alcoholism, talk to your doctor about how to manage your symptoms. 

Younger patients with nerve damage tend to fully recover. If surgery is required, it can take six to eight months.

Conclusions

Limb peripheral nerve injury is from 1.5 to 3.5% of cases of general injuries, and the lost ability to work takes one of the first places, leading to permanent disability in 28–75% of cases. Currently, the diagnosis and treatment of peripheral nerves do not have a standardized, generally accepted system for assessing the level, degree, and nature of these injuries. Patients are divided according to the level of peripheral nerve damage. This makes it possible to clarify and objectify the causes of their injuries, as well as to find mistakes made at the stages of diagnosis and treatment.

Most often, the shoulder has damaged the trunks of the radial nerve (45.8%), and on the forearm – the median and ulnar nerves (15.3%). The tactic of the “justified waiting “by surgeons of spontaneous reinnervation of axons in the nerve trunk for 8-10 months leads to unsatisfactory treatment results and even disability.

FAQs

  • How to treat damaged nerves?

The damaged nerve can be restored with the help of microsurgery and optical magnification. However, it must be sewn up immediately; otherwise, its function will never be restored. Moreover,  the chances of further vital activity of the nerve are reduced.

  • Can nerves be stitched together?

In some cases, damaged nerve fibers can be sutured by microsurgeons. However, this is painstaking work, which may not always be successful. Therefore, scientists are looking for a way to restore tissue innervation and, accordingly, impaired functions from the outside.

  • Why do doctors say that radial nerves are not being restored?

The division process is impossible; otherwise, the radial nerve cell will not be able to perform its functions because it will first need to lose all contacts and then restore them. That’s why people say that nerve cells are not restored.

  • How can people sleep with radial nerve pain?

When sleeping on your side, place a pillow in front of you to support the whole arm, limit elbow flexion, and keep the wrist and fingers flat in a neutral position. You could consider sleeping on your back with your arms at your sides or on pillows to keep your elbows and wrists in the optimal position.

  • What restores nerve tissue?

Mature oligodendrocytes can help repair nerve tissue by creating new myelin sheaths that surround nerve fibers and are responsible for transmitting nerve impulses from the brain to organs and tissues and vice versa.

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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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