What is the management plan for an adult patient with a history of needle stick injury, presenting with weakness in wrist movement, inability to lift their forearm, but able to carry a 10-pound weight, without any wound or open injury?

Management of Radial Nerve Injury Following Needle Stick

Initiate immediate dynamic splinting with wrist and finger extension support combined with intensive task-specific functional training—do not use static immobilization or serial casting, as this will worsen your weakness and delay recovery. 1, 2

Immediate Splinting Protocol

• Apply a dynamic splint that provides wrist and finger extension support through a tenodesis mechanism, allowing active movement while preventing deformity 1
• Avoid static immobilization completely—serial casting or prolonged static positioning worsens symptoms, causes muscle deconditioning, promotes learned non-use, and can trigger complex regional pain syndrome 1, 3
• Reassess splint fit and function every 2-3 weeks to adjust for recovery progress 1

Primary Rehabilitation: Task-Specific Functional Training

Your ability to carry 10 pounds but inability to lift your forearm indicates incomplete radial nerve recovery requiring structured motor retraining. 2, 3

Core Exercise Program

• Perform repetitive, goal-oriented functional activities that require active use of your affected hand in normal movement patterns with proper alignment 2
• Focus on tasks that progressively challenge wrist extension and finger control with graded difficulty 2, 3
• Include bilateral upper extremity tasks where your affected hand stabilizes objects during activities 1
• Practice placing your hand on surfaces while standing and performing even weight-bearing activities 1

Resistance Training Protocol

• Begin with low-intensity resistance at 40% of 1-repetition maximum with 10-15 repetitions, 2-3 times per week 2, 3
• Progress to moderate intensity (41-60% of 1-RM) with 8-10 repetitions only when 15 repetitions become only somewhat difficult (Borg RPE 12-14) 2
• Do not progress resistance too quickly—start with very low intensity during initial sessions to avoid muscle damage 3
• Perform static stretches held for 10-30 seconds with 3-4 repetitions for each stretch, 2-3 times per week 2, 3

Adjunctive Therapy: Functional Electrical Stimulation

Add FES to your wrist and forearm extensor muscles if you demonstrate impaired muscle contraction during therapy sessions 2, 3

• FES provides short-term increases in motor strength and motor control when combined with task-specific training 1, 2
• Use FES as an adjunct to motor practice, not as standalone treatment 2, 3
• FES promotes neural reorganization by providing sensory input and facilitating more complete muscle contractions 2

Home Exercise Program

Your primary therapy should be a directed home exercise program—evidence shows home programs are equivalent to supervised therapy for uncomplicated radial nerve palsy cases like yours 1

• Perform active finger motion exercises regularly, including stretching exercises for wrist flexors and extensors 1
• Grade activities progressively to increase the time your affected hand is used within functional tasks 1
• Avoid compensatory strategies that reinforce abnormal movement patterns 1

Critical Management Principles: What NOT to Do

• Never position your wrist at end ranges for prolonged periods—this exacerbates symptoms and may impede recovery 2, 3
• Do not rely on passive range of motion alone—active motor practice is essential for recovery 3
• Avoid static immobilization that prevents restoration of normal movement and function 2

Expected Recovery Timeline and Prognosis

Your resolved wrist drop indicates significant motor recovery has already occurred, which is a positive prognostic indicator. 3

• Most motor recovery gains occur within the first 6 months, making this a critical window for intensive rehabilitation 3
• Optimal functional recovery requires 9-12 months of continued rehabilitation depending on your return-to-work goals 2, 3
• The absence of motor function outside extension represents incomplete recovery that will not spontaneously improve without structured resistance training and task-specific practice 3

Monitoring and Follow-Up

• Reassess function every 2-3 weeks to evaluate splint effectiveness and adjust therapy progression 1
• Monitor for unremitting pain during follow-up, which would warrant reevaluation 2
• Video recording of your movements (with consent) can demonstrate changeability in symptoms and serve as reference points for replicating successful strategies 1

Common Pitfall

The single most important pitfall to avoid is assuming your partial recovery will continue without structured intervention—your current plateau with inability to lift your forearm despite carrying capacity indicates you need the full rehabilitation protocol outlined above, not watchful waiting. 2, 3