What is the best course of treatment for a patient with improved sensation, mild weakness in grip, and limited wrist extension, but able to grip and close/open fingers, after experiencing a wrist drop?

Rehabilitation with Task-Specific Wrist Extension Exercises and Progressive Resistance Training

For a patient with recovering radial nerve function showing preserved grip strength and finger movement but persistent wrist drop weakness, implement a structured rehabilitation program centered on task-specific wrist extension practice combined with progressive resistance training for 9-12 months, while avoiding splinting that could impede functional recovery. 1, 2

Core Rehabilitation Strategy

Your patient demonstrates favorable prognostic indicators—preserved sensation, grip function, and finger movement—suggesting good potential for functional recovery through targeted rehabilitation rather than surgical intervention. 1

Primary Exercise Program

Task-specific practice focusing on wrist extension movements should form the foundation of treatment. 1, 2 This approach directly addresses the primary deficit (weak wrist extension) while capitalizing on preserved grip and finger function.

Implement a structured flexibility and resistance training protocol: 1, 2

• Flexibility training: 2-3 times per week, holding static stretches for 10-30 seconds with 3-4 repetitions per stretch 1, 2
• Resistance training progression:
  • Begin with low-intensity exercises at 40% of 1-repetition maximum (1-RM) performing 10-15 repetitions 1, 2
  • Progress to moderate intensity (41-60% of 1-RM) with 8-10 repetitions as tolerated 1, 2
  • Advance resistance when 15 repetitions become only somewhat difficult (Borg RPE 12-14) 1

Continue rehabilitation for 9-12 months depending on return-to-work goals and functional demands. 1, 2

Critical Management Principles

Avoid splinting, as it may prevent restoration of normal movement and function. 1, 2, 3 This is particularly important given your patient's preserved grip and finger function—splinting could actually impede the recovery trajectory.

Do not position the wrist at end ranges for prolonged periods, as this exacerbates symptoms. 1, 2, 3

Ensure active finger motion exercises continue throughout treatment to maintain the preserved grip and finger function. 4

Advanced Intervention Considerations

Functional Electrical Stimulation (FES) may be considered if muscle contraction remains impaired despite conservative rehabilitation, as it produces short-term increases in motor strength and motor control for wrist motor impairment. 2 Research supports that electrical stimulation can increase wrist extension range in patients with extension deficits and improve strength in those with some voluntary wrist extension. 5

Monitoring and Progression

Track these specific parameters to guide treatment advancement:

• Wrist extension degrees (active range of motion) 2
• Grip strength measurements using hydraulic dynamometry 6
• Functional status using patient-rated wrist evaluation or DASH scores 7, 6
• Pain levels to ensure exercises are not causing tissue irritation 7

Surgical Consideration Threshold

While your patient's presentation favors conservative management, be aware that anterior cervical decompression provides more rapid relief (within 3-4 months) and longer-term improvement (12 months) in wrist extension compared to physical therapy if cervical radiculopathy is the underlying cause. 4 However, this applies specifically to cervical nerve root compression scenarios, not peripheral radial nerve recovery.

Tendon transfer surgery becomes relevant only if conservative rehabilitation fails after an adequate trial period (typically 9-12 months) and functional deficits persist. 6