Radial Mononeuropathy Treatment & Management

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

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 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.[10]
  • With posterior interosseous neuropathies, repetitive supination of the forearm should be avoided.
  • In distal radial sensory nerve lesions, management is typically conservative.
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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.[11]
  • Consensus has not been reached regarding the need for and timing of surgical therapy to treat radial nerve palsy with accompanying humeral fracture.[12, 13, 14]
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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
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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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  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].

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