Management of Resolved Radial Nerve Palsy Following Deltoid Needle Injury
Since your radial nerve palsy has completely resolved with spontaneous recovery of the 3rd finger drop, no surgical intervention is needed—continue with physiotherapy to maintain full range of motion and monitor for any recurrence over the next 3-6 months. 1, 2
Immediate Management Approach
Your case represents an iatrogenic radial nerve injury from a deltoid injection that has already demonstrated spontaneous recovery, which is the most favorable prognostic indicator. 1
Why Surgery Is Not Indicated
- Complete functional recovery has occurred: The resolution of your finger drop indicates the nerve was likely compressed or had neuropraxia rather than transection, making surgical exploration unnecessary. 1, 2
- Surgical exploration is reserved for: Open injuries with obvious nerve transection, lack of clinical improvement after 3-6 months of conservative treatment, or evidence of severe nerve damage on imaging. 3, 2
- Your injury mechanism (needle prick) rarely causes complete nerve transection: Unlike open fractures where 64% show nerve laceration or entrapment, iatrogenic needle injuries typically cause temporary compression or inflammation. 3
Current Treatment Plan
Physiotherapy Protocol
- Maintain full passive range of motion in all affected joints (wrist, fingers, elbow) even though function has returned—this prevents contractures and optimizes long-term outcomes. 1, 2
- Active strengthening exercises should now focus on rebuilding any residual weakness in wrist extensors, finger extensors, and thumb abduction. 1
- Duration: Continue physiotherapy for at least 3 months post-recovery to ensure complete functional restoration. 2
Monitoring Timeline
- Clinical recovery typically occurs between 2 weeks and 6 months for radial nerve injuries, and you are within this window with favorable recovery. 2
- Follow-up assessment at 3 months: Ensure no recurrence of symptoms and confirm full strength has returned. 2
- If any new weakness develops: This would warrant electrodiagnostic studies (EMG/NCS) and possible ultrasound imaging to assess nerve integrity. 2
Why Conservative Management Succeeds
- The majority of radial nerve palsies recover spontaneously, particularly when caused by compression rather than laceration. 1, 2
- Early signs of recovery (which you have demonstrated) predict excellent long-term outcomes without surgical intervention. 2
- Nerve transfers or tendon transfers are only considered when no recovery occurs by 10-12 months, which does not apply to your resolved case. 2
Critical Monitoring Points
- Watch for recurrence: Any return of finger drop, wrist drop, or sensory changes along the radial forearm should prompt immediate re-evaluation. 4
- Avoid repeat trauma to the deltoid region during this recovery period. 4
- Complete recovery is expected: Given your current trajectory, full functional restoration without residual deficits is the anticipated outcome. 1, 2