I have had radial nerve palsy with wrist drop for 18 days and am receiving full therapy; will I recover?

Radial Nerve Palsy Recovery at 18 Days

You have an excellent chance of full recovery, as most radial nerve palsies—particularly those from compression or minor trauma—spontaneously resolve within 3-6 months, with initial signs of recovery typically appearing between 2 weeks and 6 months. 1

Understanding Your Current Timeline

At 18 days post-injury, you are still within the early recovery window where nerve regeneration is actively occurring but may not yet be clinically apparent:

• Initial recovery signs typically emerge between 2 weeks and 6 months after injury, meaning you are just entering the earliest possible window for visible improvement 1
• Electrodiagnostic testing performed before 7 days or after 14-21 days may provide unreliable prognostic information due to ongoing Wallerian degeneration, so testing at your current timepoint (18 days) would be most informative if complete paralysis is present 2
• The optimal window for electrodiagnostic testing is 7-14 days after symptom onset for complete paralysis, though you are slightly beyond this window 2

Prognosis Based on Injury Severity

Your recovery likelihood depends critically on whether your paralysis is complete or incomplete:

If You Have Incomplete Paralysis (Some Movement Present)

• Recovery rates approach 94% with incomplete paralysis, making your prognosis excellent 3
• Incomplete paralysis is characterized by visible muscle contraction with some antigravity effort, though movement is weak and fatigues rapidly 2
• Electrodiagnostic testing is NOT recommended for incomplete paralysis as clinical examination suffices and testing provides no additional benefit 2

If You Have Complete Paralysis (No Visible Movement)

• Approximately 70% of patients with complete paralysis recover fully within 6 months 3
• Electrodiagnostic testing should be considered only for complete paralysis to provide prognostic information using electroneuronography (ENoG) comparing affected to unaffected side 2
• If response amplitude is >10% of the contralateral side, most patients recover normal function; if <10%, a higher percentage experience incomplete recovery 2

Critical Management During Recovery Period

Continue Aggressive Splinting and Therapy

• Therapy after radial nerve injury is geared toward maintaining passive extension of the wrist and digits to prevent contractures while nerve regeneration occurs 4
• Tenodesis extension splinting allows patients to extend fingers and thumb via a tenodesis effect at the wrist, maximizing functional use during recovery 4
• Physical therapy interventions post-injury result in significant improvements in muscle strength, range of motion, and functional independence 5

Monitor for Recovery Signs

• Most palsies resolve after 6 months, with about one-third resolving within 8 weeks 6
• Watch for any return of muscle contraction, starting with wrist extensors, then finger extensors, then thumb extensors
• If no recovery is apparent by 6 months, approximately 40% of patients demonstrate serious underlying pathology warranting further evaluation 6

Surgical Intervention Timing (If Recovery Fails)

Understanding the surgical timeline helps contextualize your current conservative management:

• Early intervention within 6 months of injury is associated with superior functional recovery 7
• Nerve transfers performed by an experienced team give satisfactory results and can be offered up to 10 months post-injury 1
• Tendon transfers are the gold standard treatment and the only option available beyond 10-12 months, with reliable and fast results 1

Common Pitfalls to Avoid

• Do not discontinue splinting prematurely, as maintaining passive extension prevents contractures that could limit final functional outcome even if nerve recovery occurs 4
• Do not assume lack of recovery at 18 days indicates permanent injury, as the earliest recovery signs typically appear between 2 weeks and 6 months 1
• Do not delay electrodiagnostic testing beyond 3 months if you have complete paralysis with no signs of recovery, as this information guides surgical decision-making 2

Your Action Plan

Continue your current therapy program aggressively while maintaining realistic expectations that visible recovery may not appear for several more weeks to months 4, 5. Reassessment at 3 months is critical—if no recovery signs are present by then, electrodiagnostic testing and surgical consultation become appropriate 1. The majority of radial nerve palsies recover spontaneously, particularly if your injury resulted from compression rather than complete nerve transection 6, 1.