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Radial Mononeuropathy Clinical Presentation

  • Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
 
Updated: Mar 30, 2016
 

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

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.[2]
    • Radial neuropathy has also been reported in wheelchair users, when the spiral groove of the humerus is compressed on a hard wheelchair surface.[3]
  • 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.[4]
    • 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[5] , 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.[6]
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Contributor Information and Disclosures
Author

Wayne E Anderson, DO, FAHS, FAAN Assistant Professor of Internal Medicine/Neurology, College of Osteopathic Medicine of the Pacific Western University of Health Sciences; Clinical Faculty in Family Medicine, Touro University College of Osteopathic Medicine; Clinical Instructor, Departments of Neurology and Pain Management, California Pacific Medical Center

Wayne E Anderson, DO, FAHS, FAAN is a member of the following medical societies: California Medical Association, American Headache Society, San Francisco Medical Society, San Francisco Medical Society, International Headache Society, California Neurology Society, San Francisco Neurological Society, American Academy of Neurology, California Medical Association

Disclosure: Received honoraria from Teva for speaking and teaching; Received grant/research funds from Allergan for other; Received honoraria from Insys for speaking and teaching; Received honoraria from DepoMed for speaking and teaching.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Neil A Busis, MD Chief of Neurology and Director of Neurodagnostic Laboratory, UPMC Shadyside; Clinical Professor of Neurology and Director of Community Neurology, Department of Neurology, University of Pittsburgh Physicians

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

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, MHA, CPE Founding Editor-in-Chief, eMedicine Neurology; Founder and CEO/CMO, PHLT Consultants; Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, MHA, CPE is a member of the following medical societies: Alpha Omega Alpha, American Association for Physician Leadership, American Academy of Neurology

Disclosure: Nothing to disclose.

Additional Contributors

Aashit K Shah, MD, FAAN, FANA Professor and Associate Chair of Neurology, Director, Comprehensive Epilepsy Program, Program Director, Clinical Neurophysiology Fellowship, Detroit Medical Center, Wayne State University School of Medicine

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

Disclosure: Received consulting fee from UCB pharma for speaking and teaching; Received grant/research funds from UCB Pharma for other; Received consulting fee from Sunovion for speaking and teaching; Received consulting fee from Lundbeck for speaking and teaching.

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