Radial Mononeuropathy Clinical Presentation
- Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE more...
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.
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.
See the list below:
- 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.
- 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.
- Isolated distal sensory radial neuropathy is associated with compression from handcuffs and tight bracelets.
Rommens PM, Kuechle R, Bord T, Lewens T, Engelmann R, Blum J. Humeral nailing revisited. Injury. 2008 Apr 14. [Medline].
Pidhorz L. Acute and chronic humeral shaft fractures in adults. Orthop Traumatol Surg Res. 2015 Feb. 101 (1 Suppl):S41-9. [Medline].
Moore FG. Radial neuropathies in wheelchair users. Am J Phys Med Rehabil. 2009 Dec. 88(12):1017-9. [Medline].
Furuta T, Okamoto Y, Tohno E, Minami M, Nishiura Y, Ohtomo K. Magnetic resonance microscopy imaging of posterior interosseous nerve palsy. Jpn J Radiol. 2009 Jan. 27(1):41-4. [Medline].
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. 2009 Apr. 12(2):111-5. [Medline]. [Full Text].
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. 2008 May 10. [Medline].
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. 2010 Feb. 41(2):287-8. [Medline].
Visser LH. High-resolution sonography of the superficial radial nerve with two case reports. Muscle Nerve. 2009 Mar. 39(3):392-5. [Medline].
Lee FC, Singh H, Nazarian LN, Ratliff JK. High-resolution ultrasonography in the diagnosis and intraoperative management of peripheral nerve lesions. J Neurosurg. 2010 Mar 12. [Medline].
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. 2009 Aug 11. [Medline].
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]. 2008 Feb. 33(2):223-31. [Medline].
Dabas V, Suri T, Surapuraju PK, Sural S, Dhal A. Functional restoration after early tendon transfer in high radial nerve paralysis. J Hand Surg Eur Vol. 2011 Feb. 36(2):135-40. [Medline].
Bishop J, Ring D. Management of radial nerve palsy associated with humeral shaft fracture: a decision analysis model. J Hand Surg Am. 2009 Jul-Aug. 34(6):991-6.e1. [Medline].
Hak DJ. Radial nerve palsy associated with humeral shaft fractures. Orthopedics. 2009 Feb. 32(2):111. [Medline].
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. 2009 Mar. 66(3):800-3. [Medline].
Venouziou AI, Dailiana ZH, Varitimidis SE, Hantes ME, Gougoulias NE, Malizos KN. Radial nerve palsy associated with humeral shaft fracture. Is the energy of trauma a prognostic factor?. Injury. 2011 Nov. 42(11):1289-93. [Medline].
Campbell WW. Focal neuropathies. Campbell WW, ed. Essentials of Electrodiagnostic Medicine. Baltimore, Md: Williams & Wilkins; 1999. 255-278.
Fardin P, Negrin P, Sparta S, et al. Posterior interosseous nerve neuropathy. Clinical and electromyographical aspects. Electromyogr Clin Neurophysiol. 1992 Apr-May. 32(4-5):229-34. [Medline].
Fluri F, Lyrer P, Gratwohl A, Raetz-Bravo AE, Steck AJ. Lead poisoning from the beauty case: neurologic manifestations in an elderly woman. Neurology. 2007 Aug 28. 69(9):929-30. [Medline].
Hanz KR, Saint-Cyr M, Semmler MJ, Rohrich RJ. Extensor tendon injuries: acute management and secondary reconstruction. Plast Reconstr Surg. 2008 Mar. 121(3):109e-120e. [Medline].
Leis AA, Wells KJ. Radial nerve cutaneous innervation to the ulnar dorsum of the hand. Clin Neurophysiol. 2008 Mar. 119(3):662-6. [Medline].
Malikowski T, Micklesen PJ, Robinson LR. Prognostic values of electrodiagnostic studies in traumatic radial neuropathy. Muscle Nerve. 2007 Sep. 36(3):364-7. [Medline].
Pollock FH, Drake D, Bovill EG, et al. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg Am. 1981 Feb. 63(2):239-43. [Medline].
Shapiro BE, Preston DC. Entrapment and compressive neuropathies. Med Clin North Am. 2003 May. 87(3):663-96, viii. [Medline].
Stone DA, Laureno R. Handcuff neuropathies. Neurology. 1991 Jan. 41(1):145-7. [Medline].
Toros T, Ozaksar K, Sügün TS, Kayalar M, Bal E, Ada S. The effect of medial side repair in terrible triad injury of the elbow. Acta Orthop Traumatol Turc. 2012. 46(2):96-101. [Medline].
Turner OA, Taslitz N, Ward S. The radial nerve. Handbook of Peripheral Nerve Entrapments. Clifton, NJ: Humana Press; 1990. 79-91.
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. 2005 Apr 30. 7(2):187-97. [Medline].