Radial Nerve Recovery Assessment
Yes, resolution of middle finger drooping is encouraging and indicates partial nerve recovery, but persistent wrist weakness with inward coiling (wrist drop) suggests incomplete radial nerve regeneration that requires continued observation and supportive management.
Understanding Your Current Status
Your presentation indicates partial radial nerve recovery with a specific pattern:
- Improved finger extension (middle finger no longer drooping) suggests the posterior interosseous nerve branch is recovering, which controls finger and thumb extension 1, 2
- Persistent wrist weakness with inward coiling indicates the extensor carpi radialis brevis branch remains impaired, which is responsible for wrist extension 3, 2
- Absence of edema or wound is favorable, as it suggests no active infection or compartment syndrome complications 4
What This Pattern Means Prognostically
The distal-to-proximal recovery pattern you're experiencing is actually common and generally favorable:
- Radial nerve injuries typically show wrist extension recovery in at least 80% of patients regardless of injury level, though finger extension recovery varies more by injury location 2
- Recovery occurring within the first several months is a positive prognostic indicator, as radial nerve outcomes are significantly better when recovery begins within 5 months of injury 2
- Your finger improvement suggests ongoing nerve regeneration rather than complete nerve disruption 5, 2
Immediate Management Recommendations
Active Rehabilitation (Critical - Start Now)
- Begin active finger motion exercises immediately to prevent stiffness, performing complete range of motion multiple times daily 6
- Initiate wrist mobilization exercises as tolerated, focusing on flexion, extension, and rotation 6
- Finger motion does not adversely affect nerve recovery and prevents the most functionally disabling complication—hand stiffness 6
Orthotic Support
- A dynamic wrist-finger-thumb extension orthosis should be provided to support wrist position and prevent contractures while awaiting full recovery 7
- This addresses your biological needs (maintaining soft tissue length) while preserving hand function during recovery 7
Observation Timeline and Red Flags
Expected Recovery Window
- Continue conservative observation for up to 6 months from injury, as most closed radial nerve injuries recover spontaneously without surgical intervention 4
- Document whether nerve dysfunction appeared immediately after fracture or developed later, as this affects prognosis 4
Warning Signs Requiring Immediate Reevaluation
The American Academy of Orthopaedic Surgeons emphasizes these critical red flags 1, 4:
- Unremitting pain or new symptoms during follow-up (may indicate nerve compression)
- Complete loss of previously recovered function (suggests secondary nerve palsy or entrapment requiring urgent intervention)
- No clinical or electrodiagnostic evidence of recovery at 6 months (may warrant surgical exploration)
Surgical Considerations (If Recovery Plateaus)
Surgery should only be considered in specific circumstances 4:
- Persistent nerve dysfunction at 6 months with no clinical or electrodiagnostic evidence of recovery
- Evidence from the American Academy of Orthopaedic Surgeons states there is insufficient evidence to recommend for or against nerve decompression when nerve dysfunction persists after reduction 8
If surgical intervention becomes necessary after 6 months of no recovery, median to radial nerve transfers have demonstrated excellent outcomes, with potential to restore normal radial nerve function including independent finger motion 5, 9, 3
Critical Pitfall to Avoid
Never delay or restrict finger and wrist exercises during this observation period, as failure to maintain joint mobility leads to permanent stiffness that is extremely difficult to reverse and may require extensive therapy or surgical intervention 6