Management of Arm Heaviness in Radial Nerve Dysfunction Without Sling Use
For a patient with radial nerve dysfunction experiencing arm heaviness without edema who is not using a sling, actively engage the limb in functional tasks that promote normal movement patterns and avoid prolonged immobilization, as splinting and sling use can lead to muscle deconditioning, learnt non-use, and potentially worsen symptoms. 1
Primary Management Strategy: Active Functional Engagement
The core approach is to discourage "nursing" of the affected limb and instead promote therapeutic positioning and active use throughout the day. 1
Specific Interventions for Limb Heaviness
Support the affected limb when at rest using pillows or furniture to take the weight off while sitting or lying down, which reduces muscle overactivity, pain, and fatigue without resorting to continuous sling use 1
Engage in tasks that promote normal movement, good alignment, and even weight-bearing such as placing the hand on a kitchen bench while standing to prepare food (rather than letting it hang by the side), using the hand to stabilize objects during activities, and incorporating the limb into bilateral tasks 1
Grade activity progressively to increase the time the affected limb is used within functional activities, starting with simple stabilization tasks and advancing to more complex movements 1
Positioning Recommendations
Maintain optimal postural alignment at rest and during function with a 24-hour management approach that includes even distribution of weight in sitting, transfers, standing, and walking to normalize movement patterns and muscle activity 1
Avoid prolonged pressure on the radial nerve in the spiral groove of the humerus from contact with hard surfaces, as this can exacerbate nerve dysfunction 1
Position the forearm in neutral or supinated positions to minimize nerve compression, avoiding positions that place the nerve under tension 1
Critical Pitfall: Avoiding Continuous Sling Use
Continuous sling use should be avoided as it can lead to multiple complications: 1
- Increased attention and focus to the affected area, potentially exacerbating symptoms 1
- Increased accessory muscle use and compensatory movement strategies 1
- Immobilization leading to muscle deconditioning 1
- Learnt non-use of the limb 1
- Increased pain 1
When Temporary Support May Be Appropriate
If temporary support is needed for severe symptoms, use removable splints only intermittently and monitor regularly, empowering the patient to discontinue use if adverse effects develop 1
For radial sensory nerve entrapment in the distal forearm, temporary thumb spica splinting may provide relief in select cases, but this should not be continuous 2
Therapeutic Exercise Approach
Employ muscle relaxation strategies to reduce muscle overactivity and fatigue associated with the sensation of heaviness 1
Use anxiety management and distraction techniques when undertaking tasks, as these can be helpful across all symptom types 1
Encourage "slow" movement activities such as yoga or tai chi as methods of regaining movement control and redirecting attention away from symptoms 1
Monitoring and Progression
Periodically assess upper extremity position and function to ensure maintenance of desired positioning and to track improvement 1
Video recording interventions (with consent) can demonstrate changeability, highlight successes, build confidence, and serve as a reference point for replicating successful strategies 1
Red Flags Requiring Further Evaluation
Progressive motor weakness or sensory loss indicates evolving pathology requiring immediate imaging and specialist evaluation 3
Absent pulses with unilateral symptoms suggest vascular emergency requiring immediate vascular surgery consultation 3
Severe pain limiting cooperation can make clinical evaluation impossible and may indicate need for pain management before functional rehabilitation 4