What is the typical recovery time for radial nerve (radial nerve) palsy in the arm?

Recovery Time for Radial Nerve Palsy in the Arm

Most patients with radial nerve palsy associated with humeral fractures begin showing signs of recovery between 2 weeks and 6 months, with complete recovery typically occurring at an average of 22-27 weeks (approximately 5-6 months), though the majority achieve full recovery within 6-8 months. 1, 2, 3

Expected Recovery Timeline

Initial Recovery Phase

• First signs of nerve recovery typically appear between 10-16 weeks after injury, with primary radial nerve palsy showing onset of recovery at an average of 10.5 weeks and secondary (iatrogenic) palsy at 8.9 weeks 2, 4
• The earliest recovery can begin as soon as 4-5 weeks, while some patients may not show initial signs until 30 weeks 1, 4

Complete Recovery Phase

• Full recovery or significant improvement occurs at an average of 22.9-26.7 weeks (approximately 5-6.5 months) across multiple studies 1, 2
• Recovery follows a predictable pattern: wrist extension recovers first at an average of 3 months (range 2-26 weeks), followed by finger extension 2-6 weeks later 1
• The median time to complete recovery is 26 weeks 1

Overall Prognosis

• 89-100% of patients achieve complete recovery of radial nerve function with appropriate management 1, 5
• Among conservatively managed patients, 89% display complete recovery while 11% present minor sequelae 5
• With early operative exploration and decompression, 100% recovery rates have been reported 1

Factors Affecting Recovery Duration

Type of Palsy

• Secondary (iatrogenic) radial nerve palsy shows a tendency for earlier recovery compared to primary palsy, though both achieve similar final outcomes 2
• The trauma mechanism and type of treatment (operative vs. nonoperative) have no significant influence on time to recovery 2

Severity of Injury

• Recovery time ranges from 4 to 32 weeks depending on the degree of nerve damage 1
• Patients with nerve continuity on exploration typically follow the expected recovery timeline 4

Clinical Management During Recovery Period

Observation Period

• A minimum observation period of 4 months is recommended before considering surgical exploration for persistent palsy 4
• Initial signs of recovery may appear between 2 weeks and 6 months, so patience during this window is essential 3

Surgical Intervention Timing

• If no recovery occurs, nerve exploration decisions should be made based on electroneuromyography and ultrasonography findings 3
• Autograft is indicated only in younger patients before 6 months if local conditions are suitable 3
• Nerve transfers can be offered up to 10 months post-injury by experienced teams 3
• Tendon transfers are the only option beyond 10-12 months and represent the gold standard for late reconstruction 3

Common Pitfalls to Avoid

• Do not rush to surgical exploration for iatrogenic palsy - the recovery pattern is similar to primary palsy, and observation for at least 4 months is appropriate unless there is obvious misplaced instrumentation 4
• Do not assume lack of recovery at 3 months indicates permanent damage - some patients show first signs of recovery as late as 30 weeks 1, 4
• Do not delay definitive reconstruction beyond 12 months - tendon transfers should be performed before this window closes 3

Long-Term Functional Outcomes

• Patients who achieve complete nerve recovery demonstrate functional outcomes and quality of life comparable to those with healed humeral fractures without nerve palsy at long-term follow-up (mean 7 years) 5
• Disability of the Arm, Shoulder and Hand (DASH) scores range from 0 to 11.8 at greater than 1 year post-operatively in successfully recovered patients 1