Will I recover from weakness, numbness, and tingling in my arm and hand, with inability to fully extend my fingers and wrist, and inward coiling of my left hand, without any signs of redness or swelling?

Urgent Neurological Evaluation Required for Suspected Radial Nerve Palsy

You need immediate medical evaluation, but the prognosis for recovery is generally favorable—most radial nerve injuries recover spontaneously within 3-6 months, with initial signs of improvement typically appearing within 7 weeks. 1

Your Symptoms Indicate Radial Nerve Injury

Your presentation—inability to fully extend fingers and wrist (close-open difficulty), inward coiling of the hand, whole arm heaviness, and weak wrist without redness or swelling—is classic for radial nerve palsy, the most frequently injured major nerve in the upper limb. 2

Key Clinical Features You're Experiencing:

• Wrist drop (inability to extend wrist, causing inward coiling) 2, 3
• Finger extension weakness (difficulty with close-open movements) 4
• Arm heaviness (motor weakness along radial nerve distribution) 5
• Absence of inflammation (no redness/swelling rules out acute inflammatory conditions) 5

Most Likely Causes to Investigate

Trauma-Related (Most Common):

• Humeral fracture is the leading cause, as the radial nerve runs close to the humeral shaft 2, 1
• Compression injury from prolonged pressure during sleep, anesthesia, or positioning 3
• Penetrating trauma or gunshot injury 2

Non-Traumatic Causes:

• Iatrogenic injury from injections or surgical procedures 3
• Tumor compression along the nerve course 3
• Anomalous muscle compression (rare anatomical variants) 3

Recovery Prognosis: Generally Excellent

The critical distinction determining your recovery is whether the nerve is intact or transected:

If Nerve is Intact (Most Likely in Your Case):

• Recovery rate: Nearly 100% for closed injuries without nerve transection 1
• Time to first signs of recovery: Average 7 weeks (range 1-25 weeks) 1
• Time to full recovery: Average 6 months (range 1-21 months) 1
• Radial nerve injuries are the least debilitating of upper limb nerve injuries 2

If Nerve is Transected (Unlikely Without Open Injury):

• Occurs almost exclusively with open fractures and complex upper-extremity trauma 1
• Requires surgical repair, though outcomes are poor with primary repair (0% recovery in one series) 1
• Your lack of open wound makes this scenario improbable 1

Immediate Management Steps

Conservative Treatment (First-Line):

Maintain full passive range of motion in all affected joints to prevent contractures while awaiting nerve recovery 2. This is the most critical aspect of conservative management.

• Wrist splinting in neutral or slight extension to prevent deformity 5
• Physical therapy for passive range-of-motion exercises 2
• Pain management with duloxetine (30-50% pain reduction) if neuropathic pain develops 6

When Surgery is Indicated:

Surgical exploration is necessary only if: 2

• Obvious nerve transection (open injuries)
• No clinical improvement after 3-6 months of conservative treatment
• Progressive worsening of symptoms

Critical Diagnostic Workup Needed

Essential Tests to Localize and Confirm:

• Electromyography (EMG) and nerve conduction studies to confirm radial nerve injury and exclude other diagnoses 5, 7
• Plain radiographs of humerus and elbow to identify fractures 1
• MRI of arm if tumor or soft tissue mass suspected 3

Differential Diagnoses to Exclude:

• Posterior interosseous nerve syndrome (weakness without sensory loss) 4
• Cervical radiculopathy (C7 root affecting radial nerve distribution) 5
• Guillain-Barré syndrome (if bilateral or rapidly progressive with areflexia) 8

Monitoring During Recovery

Serial examinations every 2-4 weeks are essential to track recovery and identify complications early 4. Look for:

• Tinel's sign progression distally (indicates nerve regeneration) 2
• Return of wrist extension (first sign of motor recovery) 1
• Finger extension recovery (follows wrist recovery) 1

Red Flags Requiring Urgent Re-evaluation:

• Worsening weakness after initial stability 8
• Development of respiratory symptoms (suggests systemic neuropathy like GBS) 8
• Bilateral symptoms (indicates systemic cause, not isolated radial nerve injury) 5

Bottom Line on Recovery

Your prognosis is excellent if this is an isolated radial nerve injury without transection. 1 The absence of open trauma, the typical presentation, and the natural history of radial nerve injuries all favor spontaneous recovery within 6 months. 2, 1 However, immediate medical evaluation is mandatory to confirm the diagnosis, exclude serious underlying causes, and initiate proper conservative management to prevent permanent disability. 2