Radial Mononeuropathy Clinical Presentation

  • Author: Wayne E Anderson, DO; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Jun 11, 2010
 

History

Symptoms are dependent on the site of the lesion.

  • The most common reported symptom is wrist drop.
  • If the lesion is high above the elbow, then numbness of the forearm and hand may be an additional symptom.
  • If the lesion is in the forearm, sensation typically is spared despite the wrist drop.
    • Pain in the forearm resembling tennis elbow may be prominent.
    • This presentation is initially acute for several days to weeks.
  • If the lesion is at the wrist, patients report isolated sensory changes and paresthesias over the back of the hand without motor weakness.
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Physical

Radial neuropathy typically presents with weakness of wrist dorsiflexion (ie, wrist drop) and finger extension.

  • If the lesion is in the axilla, all radial-innervated muscles are involved.
    • The triceps and brachioradialis reflexes are decreased.
    • Sensation is decreased occur over the triceps, the posterior part of the forearm, and dorsum of the hand.
  • Acute compression of the radial nerve commonly occurs at the spiral groove. If the lesion is at this level, all radial-innervated muscles distal to the triceps are weak.
    • Triceps reflex is preserved, but brachioradialis is decreased.
    • Sensory loss is over the radial dorsal part of the hand and the posterior part of the forearm.
    • Numbness over the triceps area is variable.
  • In isolated posterior interosseous lesions, sensation is spared and motor involvement occurs in radial muscles distal to the supinator.
    • Brachioradialis reflex is intact.
    • The extensor carpi radialis sometimes is also spared, resulting in radial deviation with wrist extension.
    • Pain may occur with palpation at the proximal forearm and with forceful supination.
  • In distal radial sensory lesions at the wrist, no motor weakness occurs. Numbness of the dorsal hand is noted, sparing the fifth digit.
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Causes

  • Penetrating trauma can cause injury anywhere along the nerve.
  • Compressive lesions high in the axilla can occur from improper use of crutches.
  • Compression injuries at the humeral spiral groove occur in patients with sustained compression of this area over a period of several hours.
    • This is reported in patients who fall asleep in a drunken or drug-induced stupor with the arm over a chair. It also can occur in honeymooners.
    • Fracture of the humerus is a common cause of radial neuropathy due to compression or secondary laceration of the nerve as it wraps around the humerus near the spiral groove.
    • Radial neuropathy has also been reported in wheelchair users, when the spiral groove of the humerus is compressed on a hard wheelchair surface.[2]
  • Subluxation of the radius can produce radial nerve injury in the proximal forearm.
  • The posterior interosseous syndrome typically occurs from compression of this division of the radial nerve as penetrates the supinator muscle within the proximal forearm.[3]
    • It is associated with repetitive supination of the forearm and hypertrophy of the supinator muscle.
    • It also can occur secondary to elbow synovitis, ganglion cysts[4] , enlarged bursa from the elbow, or tumors (especially lipomas at the entry of the radial nerve into the supinator muscle).
  • Isolated distal sensory radial neuropathy is associated with compression from handcuffs and tight bracelets.
  • Bilateral radial palsies suggest lead intoxication. Lead exposure may be occupational.[5]
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Contributor Information and Disclosures
Author

Wayne E Anderson, DO  Assistant Professor of Internal Medicine/Neurology, Western University of Health Sciences; Assistant Professor of Family Medicine, Touro University College of Osteopathic Medicine; Consulting Staff in Pain Management, Department of Neurology, California Pacific Medical Center; Consulting Staff in Neurology, Department of Neurology, California Pacific Medical Center

Wayne E Anderson, DO is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Law, Medicine & Ethics, California Medical Association, and San Francisco Medical Society

Disclosure: Cephalon Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; King Honoraria Speaking and teaching; Forest Honoraria Speaking and teaching

Specialty Editor Board

Aashit K Shah, MD  Associate Professor of Neurology, Wayne State University; Program Director, Clinical Neurophysiology Fellowship, Department of Neurology, Detroit Medical Center

Aashit K Shah, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, and American Epilepsy Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Neil A Busis, MD  Chief, Division of Neurology, Department of Medicine, Head, Clinical Neurophysiology Laboratory, University of Pittsburgh Medical Center-Shadyside

Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD  Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology

Disclosure: Nothing to disclose.

References

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  3. Furuta T, Okamoto Y, Tohno E, Minami M, Nishiura Y, Ohtomo K. Magnetic resonance microscopy imaging of posterior interosseous nerve palsy. Jpn J Radiol. Jan 2009;27(1):41-4. [Medline].

  4. Jou IM, Wang HN, Wang PH, Yong IS, Su WR. Compression of the radial nerve at the elbow by a ganglion: two case reports. J Med Case Reports. Jun 5 2009;3:7258. [Medline].

  5. Shobha N, Taly AB, Sinha S, Venkatesh T. Radial neuropathy due to occupational lead exposure: Phenotypic and electrophysiological characteristics of five patients. Ann Indian Acad Neurol. Apr 2009;12(2):111-5. [Medline].

  6. Lo YL, Fook-Chong S, Leoh TH, Dan YF, Tan YE, Lee MP. Rapid ultrasonographic diagnosis of radial entrapment neuropathy at the spiral groove. J Neurol Sci. May 10 2008;[Medline].

  7. Liotta G, Granata G, Librante A, Di Pasquale A, Caliandro P, Martinoli C, et al. Atypical double nerve lesion after humeral fracture: diagnosis by ultrasound. Muscle Nerve. Feb 2010;41(2):287-8. [Medline].

  8. Visser LH. High-resolution sonography of the superficial radial nerve with two case reports. Muscle Nerve. Mar 2009;39(3):392-5. [Medline].

  9. Lee FC, Singh H, Nazarian LN, Ratliff JK. High-resolution ultrasonography in the diagnosis and intraoperative management of peripheral nerve lesions. J Neurosurg. Mar 12 2010;[Medline].

  10. Bumbasirevic M, Lesic A, Bumbasirevic V, Cobeljic G, Milosevic I, Atkinson HD. The management of humeral shaft fractures with associated radial nerve palsy: a review of 117 cases. Arch Orthop Trauma Surg. Aug 11 2009;[Medline].

  11. Krishnan KG, Schackert G. An analysis of results after selective tendon transfers through the interosseous membrane to provide selective finger and thumb extension in chronic irreparable radial nerve lesions. J Hand Surg [Am]. Feb 2008;33(2):223-31. [Medline].

  12. Bishop J, Ring D. Management of radial nerve palsy associated with humeral shaft fracture: a decision analysis model. J Hand Surg Am. Jul-Aug 2009;34(6):991-6.e1. [Medline].

  13. Hak DJ. Radial nerve palsy associated with humeral shaft fractures. Orthopedics. Feb 2009;32(2):111. [Medline].

  14. Wang JP, Shen WJ, Chen WM, Huang CK, Shen YS, Chen TH. Iatrogenic radial nerve palsy after operative management of humeral shaft fractures. J Trauma. Mar 2009;66(3):800-3. [Medline].

  15. Campbell WW. Focal neuropathies. In: Campbell WW, ed. Essentials of Electrodiagnostic Medicine. Baltimore, Md: Williams & Wilkins; 1999:255-278.

  16. Fardin P, Negrin P, Sparta S, et al. Posterior interosseous nerve neuropathy. Clinical and electromyographical aspects. Electromyogr Clin Neurophysiol. Apr-May 1992;32(4-5):229-34. [Medline].

  17. Fluri F, Lyrer P, Gratwohl A, Raetz-Bravo AE, Steck AJ. Lead poisoning from the beauty case: neurologic manifestations in an elderly woman. Neurology. Aug 28 2007;69(9):929-30. [Medline].

  18. Hanz KR, Saint-Cyr M, Semmler MJ, Rohrich RJ. Extensor tendon injuries: acute management and secondary reconstruction. Plast Reconstr Surg. Mar 2008;121(3):109e-120e. [Medline].

  19. Leis AA, Wells KJ. Radial nerve cutaneous innervation to the ulnar dorsum of the hand. Clin Neurophysiol. Mar 2008;119(3):662-6. [Medline].

  20. Malikowski T, Micklesen PJ, Robinson LR. Prognostic values of electrodiagnostic studies in traumatic radial neuropathy. Muscle Nerve. Sep 2007;36(3):364-7. [Medline].

  21. Pollock FH, Drake D, Bovill EG, et al. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg Am. Feb 1981;63(2):239-43. [Medline].

  22. Shapiro BE, Preston DC. Entrapment and compressive neuropathies. Med Clin North Am. May 2003;87(3):663-96, viii. [Medline].

  23. Stone DA, Laureno R. Handcuff neuropathies. Neurology. Jan 1991;41(1):145-7. [Medline].

  24. Turner OA, Taslitz N, Ward S. The radial nerve. In: Handbook of Peripheral Nerve Entrapments. Clifton, NJ: Humana Press; 1990:79-91.

  25. Walczyk S, Pieniazek M, Pelczar-Pieniazek M, Tabasz M. Appropriateness and effectiveness of physiotherapeutic treatment procedure after tendon transfer in patients with irreversible radial nerve injury. Ortop Traumatol Rehabil. Apr 30 2005;7(2):187-97. [Medline].

 
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The Radial Nerve from Gray's Anatomy (published 1918, public domain, copyright expired).
 
 
 
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