Radial Mononeuropathy Treatment & Management

Updated: Jul 19, 2021
  • Author: Nasheed I Jamal, MD; Chief Editor: Nicholas Lorenzo, MD, CPE, MHCM, FAAPL  more...
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Treatment

Medical Care

Therapy is dependent on the site and cause of the lesion.

  • When the lesion is due to external compression at the spiral groove, removing the source of the compression and conservative management is indicated.

  • Physical therapy, occupational (hand) therapy, and wrist splinting helps in reestablishing functional use of the hand.

  • If the lesion is due to a humeral fracture, the fracture must be carefully reduced and set to avoid further injury. This may require external fixation.

  • If no recovery is noted within several months, then exploration for the site of compression or transection with possible surgical re-anastomosis may be indicated. [27]

  • With posterior interosseous neuropathies, repetitive supination of the forearm should be avoided.

  • In distal radial sensory nerve lesions, management is typically conservative.

  • Oral or topical NSAIDs along with corticosteroid injections may be used for pain relief.

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Surgical Care

Surgical exploration may be considered for a chronic compressive lesion or transection.

  • Surgical exploration frequently is indicated for release of the nerve from tethered points in the forearm.

  • Localizing the lesion prior to surgery via EMG is important to assist the surgeon in identifying which section of the nerve is most likely involved.

  • When transection is suspected as the mechanism of injury, conservative management for several months is indicated to assure that no nerve regrowth has occurred either clinically or by electrodiagnostic measures.

  • If no regeneration or inadequate regeneration is confirmed, surgical exploration with possible re-anastomosis may be indicated.

  • Selective tendon transfer may allow for finger extension and thumb extension in cases of long-standing, irreparable radial nerve lesions. [28, 29]

  • Consensus has not been reached regarding the need for and timing of surgical therapy to treat radial nerve palsy with accompanying humeral fracture. [30, 31, 32, 33]

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Consultations

Electrodiagnostic consultation is important in radial mononeuropathy in order to:

  • localize the lesion

  • provide useful prognostic information in traumatic radial neuropathy

Orthopedic hand surgery can be consulted for radial nerve injuries.

Occupational therapy for workplace modifications to avoid injury or repetitive motions that exacerbate symptoms.

Physical therapy may accelerate improvement after tendon transfer for irreversible radial nerve injury.

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Diet

Depending on the cause, patients may be advised to lower alcohol consumption or modify diet to control blood sugar levels.

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Activity

Avoid activities that can exacerbate symptoms and worsen injury such as activities involving compression along the radial nerve including the axilla or humeral region.

Avoid repetitive activities involving wrist extension and forearm rotation.

Exercise and passive movement of the elbow, forearm, and wrist should be performed to maintain full range of joint motion.

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