Radial Nerve Palsy Recovery After 21 Days of Therapy
Yes, you will almost certainly recover full wrist extension function, but complete recovery typically requires 3-6 months of continued therapy and splinting, not just 21 days. 1, 2
Expected Recovery Timeline
Your current status at 21 days is actually encouraging—the fact that your forearm flexors (ventral muscles) are intact confirms this is an isolated radial nerve injury, not a stroke or central nervous system problem. 1 However, radial nerve recovery follows a predictable but slow timeline:
- Wrist extension recovery: Expected in 80% of patients regardless of injury level, but this takes months, not weeks 3
- Optimal recovery window: Nerve repair or reconstruction within 5 months of injury yields significantly better outcomes 3
- Full functional recovery: Typically achieved at 21.5 months average follow-up in surgical series 3
Critical Next Steps
Continue aggressive wrist splinting immediately to prevent contracture while the nerve regenerates. 1, 2 The American College of Radiology specifically recommends wrist splinting in neutral or slight extension as definitive treatment for radial nerve palsy to prevent wrist drop contracture and allow nerve recovery. 1
Imaging Requirements
If you haven't already had imaging:
- Obtain plain radiographs of the entire forearm and elbow immediately to rule out occult fracture or bone lesions compressing the nerve 2
- If radiographs are normal, proceed to MRI without contrast to evaluate for nerve compression, soft tissue masses, or nerve injury 2
- Do not assume "no injury" means no fracture—occult fractures can present without recalled trauma 2
Therapy Protocol
Continue your current physiotherapy with these evidence-based additions:
- Maintain splinting 24/7 except during therapy sessions to prevent wrist drop contracture 1
- Daily passive stretching of wrist and finger extensors to maintain soft tissue length 4
- Positioning exercises: 30 minutes daily of wrist positioning in maximum extension while sitting or lying down 4
- Neuromuscular re-education as nerve function returns, focusing on quality of movement, not just strength 4
Warning Signs Requiring Urgent Surgical Referral
Refer immediately to hand surgery or neurology if: 2
- No improvement in wrist extension by 3 months (suggests complete nerve disruption requiring nerve transfer or tendon transfer)
- Progressive numbness or weakness despite therapy
- MRI reveals compressive mass or nerve discontinuity
Surgical Options If Conservative Treatment Fails
If you show no recovery by 3-5 months, surgical options have excellent outcomes:
- Nerve transfers: Median-to-radial nerve transfers restore normal function including independent finger motion, with excellent outcomes up to 10 months post-injury 5
- Tendon transfers: Achieve 202.5% improvement in grip strength and restore functional wrist/finger extension, with best results when performed within 90 days of injury 6, 7
Common Pitfalls to Avoid
- Do not stop splinting prematurely—contracture prevention is critical and requires months of consistent splinting 1
- Do not delay imaging—occult fractures or compressive masses require early identification 2
- Do not wait beyond 5 months for surgical consultation if no recovery is evident, as outcomes decline significantly after this window 3
- Do not assume physical therapy alone is sufficient—splinting is equally important to prevent contracture during the recovery period 1