I have severe wrist‑drop with absent wrist extensors, intact finger flexors allowing pinch and a 10 lb grip, and have completed rehabilitation; will I regain wrist extension?

Prognosis for Recovery of Wrist Extension After Radial Nerve Injury

Your wrist extensors are unlikely to spontaneously recover after completing rehabilitation without return of active extension, and you should pursue tendon transfer surgery to restore wrist extension function. 1, 2

Understanding Your Current Status

Your clinical picture indicates complete radial nerve palsy with the following key features:

• Absent wrist extensors = complete loss of radial nerve-innervated muscles 2
• Intact finger flexors and pinch = preserved median and ulnar nerve function 2
• 10 lb grip strength = functional flexor strength suitable for tendon transfer 3
• Completed rehabilitation = exhausted conservative treatment window 1, 4

The fact that you have no active wrist extension after completing a full rehabilitation program is the critical negative prognostic indicator. 4

Why Spontaneous Recovery is Unlikely

The absence of voluntary wrist extension after completing rehabilitation indicates permanent nerve damage. 1, 4 The typical recovery window for radial nerve injuries is 6-12 months with aggressive therapy. 1, 4 Since you've completed rehabilitation without regaining extension, the nerve has either:

• Failed to regenerate adequately
• Developed irreversible axonal damage
• Sustained a complete anatomical disruption

Your preserved grip strength and finger flexion actually confirm this is isolated radial nerve pathology, not a more diffuse problem. 2, 5

Surgical Reconstruction is Your Best Option

Tendon transfer surgery can restore functional wrist extension using your intact flexor muscles. 3 The most established procedure uses:

• Flexor carpi radialis transferred to wrist extensors = restores wrist extension 3
• Flexor carpi ulnaris transferred to finger/thumb extensors = restores finger extension 3

This "double wrist flexor" transfer has demonstrated good overall functional outcomes even with major loss of wrist flexion, because your finger flexors compensate. 3 Your 10 lb grip strength indicates you have adequate flexor power to serve as donor tendons. 3

Critical Pitfalls to Avoid

Do NOT continue with static splinting or immobilization as your primary treatment—this worsens outcomes, causes muscle deconditioning, and can trigger complex regional pain syndrome. 2

Do NOT delay surgical consultation waiting for spontaneous recovery that will not occur. 1, 2

Do NOT accept "watchful waiting" beyond the 6-12 month rehabilitation window—you've already completed this phase. 1, 4

What You Should Do Now

1. Obtain neurosurgical or hand surgery consultation for tendon transfer evaluation 2
2. Continue dynamic splinting (not static casting) to prevent contractures while awaiting surgery 2
3. Maintain finger flexor strength through resistance exercises 2-3 times weekly to optimize donor tendon quality 4
4. Consider electrodiagnostic studies (EMG/NCS) to definitively confirm complete radial nerve injury and rule out partial recovery potential 2

The presence of your functional grip and pinch makes you an excellent candidate for reconstructive surgery, which offers the only realistic path to regaining wrist extension. 3