Will motor function return in a patient with a 10-day history of radial nerve weakness, presenting with a very weak wrist but intact finger function?

Will Motor Function Return in Wrist Weakness with Preserved Finger Function?

Yes, motor function will return with appropriate rehabilitation, but recovery will NOT occur spontaneously—you must implement structured resistance training and task-specific practice immediately. 1, 2

Positive Prognostic Indicators

Your patient has excellent recovery potential based on two critical factors:

• Preserved finger function is the single most important positive prognostic indicator for upper extremity motor recovery 1, 2
• The specific pattern of isolated wrist weakness with intact finger movements indicates radial nerve involvement rather than more severe cervical cord pathology 3
• At 10 days post-injury, you are well within the critical 6-month window when most motor recovery gains occur 1, 2

Critical Management Error to Avoid

Do NOT wait for spontaneous recovery or rely on passive observation. The specific deficit pattern (preserved finger function with wrist weakness) will not spontaneously improve without structured intervention 1, 2. This is the most common pitfall in managing this presentation.

Required Rehabilitation Protocol

Primary Treatment: Task-Specific Wrist Practice

• Begin immediately with supported wrist movements on a table surface, then progress to unsupported movements as control improves 1
• Practice functional activities that progressively challenge wrist extension and flexion with graded difficulty, focusing on normal movement patterns 1
• Perform repetitive, goal-oriented activities requiring active wrist use to promote neural reorganization 1

Essential Adjunctive Therapy: Functional Electrical Stimulation (FES)

• Apply FES to the wrist and forearm extensor muscles—this is strongly recommended for this specific presentation of impaired muscle contraction with wrist motor impairment 4, 1, 2, 3
• Use FES in combination with task-specific training, not as standalone treatment 1, 2
• FES provides short-term increases in motor strength and motor control when combined with active practice 4, 1

Structured Resistance Training Protocol

• Start with low-intensity resistance at 40% of 1-repetition maximum (1-RM) with 10-15 repetitions 1, 2
• Progress to moderate intensity (41-60% of 1-RM) with 8-10 repetitions as tolerated 1, 2
• Increase resistance when 15 repetitions become only somewhat difficult (Borg RPE 12-14) 1
• Perform resistance training 2-3 times per week to allow adequate recovery between sessions 1, 2

Flexibility Work

• Implement static stretches held for 10-30 seconds with 3-4 repetitions for each stretch 1, 2
• Perform flexibility training 2-3 times per week in conjunction with resistance work 1, 2

What NOT to Do

These interventions will actively harm recovery:

• Do NOT use splinting or immobilization at this stage—this prevents restoration of normal movement, promotes learned non-use, and may trigger complex regional pain syndrome 1, 2, 3
• Avoid prolonged positioning of the wrist at end ranges, which exacerbates symptoms and impedes recovery 1, 2, 3
• Do not rely on passive range of motion alone—active motor practice is essential 1, 2

Expected Recovery Timeline

• Most motor recovery gains occur within the first 6 months—this is your critical window for intensive rehabilitation 1, 2
• Continue rehabilitation for 9-12 months depending on functional goals for optimal recovery 1, 2
• Rapid relief of symptoms typically occurs within 3-4 months with appropriate structured rehabilitation 2
• Reassess function every 2-3 weeks to evaluate progress and adjust therapy 3

Bottom Line

Motor function will return, but only with immediate implementation of the structured protocol above. The presence of voluntary finger extension indicates you have caught this at an ideal time for intervention. Start task-specific practice and FES immediately—do not wait.