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.

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]}

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.

Diet

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

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.

Medication

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Media Gallery

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

of 1

Author

Nasheed I Jamal, MD Assistant Clinical Professor, Department of Neurology, Director, UCLA Neuromuscular Medicine Fellowship Program, University of California, Los Angeles, David Geffen School of Medicine; Acting Chief, Neurology Service, Associate Chief of Neurology, Los Angeles Ambulatory Care Center, Director, Multidisciplinary Clinic, Co-Director, Tele-Polyneuropathy Clinic, Department of Neurology, VA Greater Los Angeles Healthcare System

Nasheed I Jamal, MD is a member of the following medical societies: American Academy of Neurology, American Association for the Advancement of Science

Disclosure: Nothing to disclose.

Coauthor(s)

Charley Jang, BS MD Candidate, University of California, Los Angeles, David Geffen School of Medicine

Disclosure: Nothing to disclose.

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 Neurodiagnostic 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: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Academy of Neurology<br/>Serve(d) as a speaker or a member of a speakers bureau for: American Academy of Neurology<br/>Received income in an amount equal to or greater than $250 from: American Academy of Neurology.

Chief Editor

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL Co-Founder and Former Chief Publishing Officer, eMedicine and eMedicine Health, Founding Editor-in-Chief, eMedicine Neurology; Founder and Former Chairman and CEO, Pearlsreview; Founder and CEO/CMO, PHLT Consultants; Former Chief Medical Officer, MeMD Inc

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

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 Clinical Neurophysiology Society, American Epilepsy Society, American Neurological Association

Disclosure: Received research grant from: Lundebck pharma.

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: American Academy of Neurology, American Headache Society, California Medical Association, California Neurology Society, International Headache Society, San Francisco Medical Society, San Francisco Neurological Society

Disclosure: Nothing to disclose.