Radial Mononeuropathy Treatment & Management

Updated: Jun 14, 2018
  • Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Treatment

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. [13]

  • 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. [14, 15]

  • Consensus has not been reached regarding the need for and timing of surgical therapy to treat radial nerve palsy with accompanying humeral fracture. [16, 17, 18, 19]

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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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