What is the course and treatment of radial nerve compression or damage?

From the Guidelines

Radial nerve compression or damage typically follows a course of initial pain, weakness, and sensory changes in the affected arm, with treatment varying based on severity. The radial nerve originates from the posterior cord of the brachial plexus, running down the arm, and its course can be divided into several parts:

• The radial nerve starts in the axilla, where it lies posterior to the axillary artery
• It then passes through the triangular interval, between the teres major and teres minor muscles, to enter the radial groove of the humerus
• The nerve runs down the radial groove, accompanied by the deep brachial artery, and passes through the supinator muscle
• It then divides into a superficial branch and a deep branch, with the superficial branch continuing as the superficial radial nerve and the deep branch as the posterior interosseous nerve
• The radial nerve controls wrist and finger extension, so damage typically presents as wrist drop, weakness in finger extension, and sensory loss over the posterior forearm and dorsum of the hand 1.

For mild cases, conservative management is recommended, including rest, avoiding activities that worsen symptoms, and using NSAIDs like ibuprofen (400-600mg three times daily) for pain relief. Physical therapy should be initiated early, focusing on nerve gliding exercises, stretching, and strengthening of affected muscles. Wrist splints may be prescribed to maintain proper positioning, particularly at night.

• The goal of physical therapy is to maintain range of motion, prevent contractures, and promote nerve recovery
• Nerve gliding exercises can help reduce pressure on the radial nerve and promote healing
• Strengthening exercises should be started once pain and inflammation have subsided, to prevent muscle atrophy and promote functional recovery

For moderate cases not responding to conservative measures after 6-8 weeks, corticosteroid injections may be considered. Severe cases or those with progressive neurological deficits require surgical intervention, such as nerve decompression or repair. Recovery time varies from weeks to months depending on the severity and location of injury. Regular monitoring is essential, as early intervention improves outcomes by preventing permanent muscle atrophy and contractures that can develop if treatment is delayed beyond 18-24 months 1.

In terms of prevention, careful positioning during surgery and avoiding prolonged compression of the radial nerve can help reduce the risk of injury 1. Additionally, patients with underlying medical conditions, such as diabetes, should be monitored closely for signs of radial nerve compression or damage, as they may be at higher risk of developing these conditions 1.

Overall, the key to successful treatment of radial nerve compression or damage is early intervention, careful monitoring, and a comprehensive treatment plan that addresses the underlying causes of the condition and promotes functional recovery.

From the Research

Course of Radial Nerve

• The radial nerve is a branch of the posterior cord of the brachial plexus and runs down the back of the humerus (upper arm bone) in the radial groove 2.
• It then passes through the supinator muscle and into the forearm, where it divides into superficial and deep branches 2.
• The superficial branch supplies sensation to the back of the arm and the dorsal aspect of the hand, while the deep branch supplies the extensor muscles of the wrist and fingers 2.

Compression or Damage of Radial Nerve

• Radial nerve compression can occur at various points along its course, including the elbow and wrist 2.
• Symptoms of radial nerve compression include numbness, tingling, and weakness in the hand and wrist, as well as pain in the arm and hand 3, 2.
• Treatment options for radial nerve compression include nonoperative management with corticosteroid injections, as well as surgical decompression of the nerve 3.

Treatment Options

• A study published in 2019 found that a single corticosteroid injection can be an effective treatment for radial tunnel syndrome, with significant improvements in symptoms and function at 1-year follow-up 3.
• Another study published in 2007 found that gabapentin can be used as a preemptive analgesic to reduce pain after surgery for brachial plexus injury 4.
• A 2023 study emphasized the importance of understanding the anatomical perspective of radial nerve compression in order to provide appropriate treatment 2.
• Other studies have investigated the use of gabapentin and pregabalin in the treatment of neuropathic pain, including a 2022 study that found both medications to be effective in reducing pain after transforaminal epidural steroid injection 5, 6.