Referral for Brachioradialis Weakness
Refer the patient to a hand surgeon or orthopedic surgeon specializing in upper extremity nerve injuries for evaluation and potential surgical intervention if conservative management fails. 1
Initial Specialist Referral
Primary referral should be to a hand surgeon or orthopedic upper extremity specialist who can comprehensively evaluate the radial nerve and brachioradialis function, as these specialists manage both conservative and surgical treatment of peripheral nerve injuries affecting the forearm. 1
Physical medicine and rehabilitation (PM&R) or physiatry consultation is appropriate for electrodiagnostic studies to confirm the diagnosis, localize the lesion, and establish baseline nerve function for monitoring recovery. 1
Occupational therapy referral should occur immediately and concurrently with surgical evaluation to prevent secondary complications while awaiting specialist assessment. 1
Immediate Occupational Therapy Management
While awaiting specialist evaluation, the patient requires urgent occupational therapy intervention to prevent devastating secondary complications:
Apply a dorsal cock-up splint positioning the wrist in 20-30 degrees of extension to facilitate functional hand use and prevent wrist drop deformity. 2
Initiate active finger motion exercises immediately from the time of diagnosis to prevent finger stiffness, which is one of the most functionally disabling adverse effects and can be very difficult to treat once established. 2
The splint must only stabilize the wrist and never restrict finger motion, as rigid immobilization of fingers leads to unnecessary stiffness and poor functional outcomes. 2
Additional Specialist Considerations
Neurosurgery consultation may be indicated for complex brachial plexus injuries or when nerve transfer procedures are being considered, particularly if there is evidence of more proximal nerve involvement beyond isolated brachioradialis weakness. 3
MRI evaluation of the brachial plexus may be warranted if the clinical presentation suggests plexopathy rather than isolated peripheral nerve injury, as MRI is the mainstay of plexus imaging and provides superior definition of intraneural anatomy. 1
Critical Pitfalls to Avoid
Never delay occupational therapy referral while waiting for surgical consultation, as failure to maintain joint mobility during the observation period leads to permanent stiffness that is difficult to reverse and may require multiple therapy visits or surgical intervention. 2
Do not assume all nerve injuries require immediate surgery, as most nerve injuries associated with closed injuries recover spontaneously without surgical intervention, but documentation of the timeline and progression is essential. 4
Avoid restricting finger motion with overly rigid splinting, as this creates secondary disability that can be more problematic than the original nerve injury. 2