From the Research
Radial nerve palsy should be initially managed with conservative treatment, including wrist splinting and physical therapy, with surgical exploration considered if there's no improvement after 3-4 months or if imaging shows nerve transection or severe compression, as this approach has been shown to result in satisfactory outcomes in most cases 1.
Causes and Risk Factors
Radial nerve palsy can result from various causes, including humeral fractures, direct nerve trauma, compressive neuropathies, neuritis, or malignant tumor formation 2. The proximity of the radial nerve to the humeral shaft makes it vulnerable to injury, particularly in cases of fractures or gunshot injuries 1. Iatrogenic injuries can also occur during surgical treatment of other pathologies.
Diagnosis and Treatment
Accurate diagnosis of radial nerve palsy depends on determining the cause, severity, duration, and level of involvement 2. Treatment should be tailored to the individual case, with conservative management being appropriate for most cases. Initial management includes:
- Wrist splinting in a functional position (30-45 degrees of extension) to prevent contractures while maintaining hand function
- Physical therapy, including range of motion exercises, strengthening exercises, and electrical stimulation to prevent muscle atrophy
- Oral anti-inflammatory medications, such as ibuprofen (400-600mg three times daily) or naproxen (250-500mg twice daily), for 1-2 weeks to reduce inflammation around the nerve
Surgical Exploration
Surgical exploration may be necessary if there's no improvement after 3-4 months of conservative treatment, or if imaging shows nerve transection or severe compression 1, 3. A recent systematic review found that patients who underwent surgical exploration within 3 weeks of injury had a significantly higher likelihood of regaining radial nerve function than those who underwent nonsurgical management with or without late surgical exploration 3.
Prognosis and Recovery
The prognosis for radial nerve palsy is generally good, with most patients recovering full function within 3-6 months 1, 3. Recovery can take 3-12 months, depending on the severity and location of the injury, with proximal injuries taking longer to heal due to the greater distance for nerve regeneration.
Key Points
- Conservative treatment, including wrist splinting and physical therapy, is the initial management approach for radial nerve palsy
- Surgical exploration is considered if there's no improvement after 3-4 months or if imaging shows nerve transection or severe compression
- The prognosis is generally good, with most patients recovering full function within 3-6 months
- Recovery time can vary depending on the severity and location of the injury, with proximal injuries taking longer to heal.