I have a history of radial nerve dysfunction and I'm experiencing a feeling of heaviness in my whole arm, what could be causing this?

Evaluation of New Whole Arm Heaviness in Radial Nerve Dysfunction

Your new symptom of whole arm heaviness with pre-existing radial nerve dysfunction requires immediate clinical reevaluation to rule out nerve compression, progressive neuropathy, or new structural complications.

Immediate Assessment Required

Unremitting pain or new symptoms during follow-up warrants immediate reevaluation, as this may indicate nerve compression or other complications 1. Your transition from isolated radial nerve dysfunction to whole arm heaviness represents a significant change in symptom pattern that demands urgent attention.

Key Differential Considerations

The heaviness you're experiencing could indicate:

• Progressive nerve compression - Worsening radial nerve entrapment or involvement of additional nerve structures (median, ulnar, or brachial plexus) 2
• Brachial plexus involvement - Whole arm symptoms suggest pathology beyond isolated radial nerve distribution 2
• Compartment syndrome or vascular compromise - Heaviness can indicate impaired perfusion or increased compartment pressure 1
• Hardware complications (if you've had surgical fixation) - Periscrew loosening or hardware failure can cause progressive symptoms 3

Critical Red Flags to Assess Immediately

Seek emergency evaluation if you have:

• Increasing weakness beyond your baseline radial nerve deficit 4, 1
• Numbness or tingling spreading beyond the dorsoradial hand (radial nerve distribution) 5
• Severe unrelenting pain that limits cooperation with examination 4
• Color changes or temperature differences in the arm 1
• Recent trauma or new positioning injury 6

Physical Examination Priorities

Your clinician must specifically assess:

• Radial nerve function: Wrist extension, finger extension at MCPs, thumb extension, and sensation over first dorsal web space 4, 7
• Median and ulnar nerve function: Since radial nerve compression has relatively high incidence of compressive neuropathy involving other major nerves in the same extremity 5
• Brachial plexus integrity: Shoulder abduction, elbow flexion/extension, and comprehensive upper extremity motor/sensory testing 2
• Vascular status: Pulses, capillary refill, and perfusion 1
• Positioning-related pressure points: Spiral groove of humerus (radial nerve), postcondylar groove (ulnar nerve), and acromioclavicular region (brachial plexus) 2

Imaging and Diagnostic Workup

Based on your history of radial nerve dysfunction:

• Plain radiographs if there's any history of fracture to assess for hardware loosening, nonunion, or displacement 3
• MRI or ultrasound to evaluate for space-occupying lesions, nerve compression, or soft tissue pathology 5
• Electrodiagnostic studies (EMG/NCS) to differentiate acute from chronic changes and localize the level of involvement 5

Management Algorithm

If Examination Shows Isolated Radial Nerve Symptoms:

• Continue splinting to maintain passive wrist and digit extension 8, 9, 7
• Avoid prolonged pressure on the spiral groove of the humerus 2, 1
• Position forearm in neutral or supinated position to minimize nerve compression 2

If Examination Shows Multi-Nerve or Brachial Plexus Involvement:

• Urgent surgical consultation for potential decompression 5
• Compression that doesn't improve with several months of conservative treatment (splinting, anti-inflammatory medication, activity modification) should be treated surgically to reduce permanent deficit 5

If Hardware Present with Loosening:

• Urgent surgical revision (within days to 1-2 weeks) is required 3
• Periscrew loosening represents mechanical failure requiring revision surgery to prevent nonunion or complete hardware failure 3

Common Pitfalls to Avoid

• Don't dismiss new symptoms as "just worsening" of your known radial nerve problem - whole arm heaviness suggests broader pathology 1, 5
• Don't delay evaluation if severe pain limits your ability to cooperate with examination - this itself is a red flag requiring immediate attention 4
• Don't assume sensory complaints are minor - radial nerve compression may successfully masquerade as other conditions because sensory complaints can be subtle 5
• Don't wait months for spontaneous improvement if weakness is dense or progressive - surgical decompression outcomes worsen with delay 5

Prognosis Considerations

Results after radial nerve decompression are not as favorable as those for carpal or cubital tunnel release, with worst outcomes seen in patients with chronic pain and poor symptom localization 5. This underscores the importance of early, accurate diagnosis and timely intervention.