Sections

Sections Radial Mononeuropathy
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Medication
Questions & Answers
References

Workup

Imaging Studies

A study showed that ultrasound examination can localize radial neuropathy more rapidly than standard electrophysiological testing.^{[21, 22]}Visualization of the superficial radial nerve with high-resolution sonography has recently been reported.^{[23, 24]}

Occasionally, imaging of the elbow region or the humeral area is indicated to determine if any mass or bony lesions are compressing the nerve. Plain radiographs may show bony causes of compression, such as fractures, dislocations, callus formations, or osteophytes. MRI is particularly helpful for soft tissue evaluation and more direct imaging of the nerve.^[18]

Laboratory Studies

Blood tests can be used to identify underlying conditions that may cause or contribute to generalized neuropathy and may include:

Comprehensive metabolic panel
Blood glucose and HbA1c
Vitamin B₁₂
Thyroid panel
Heavy metal blood levels
Infectious workup
Autoimmune disorders: antinuclear antibody (ANA)
Serum protein electrophoresis (SPEP)

Procedures

Nerve conduction studies and needle electromyography (EMG) are essential for specific localization and to rule out a more generalized process. Nerve conduction studies of both the superficial radial sensory and radial motor nerves should be performed. For the radial motor study, stimulation sites include the forearm, the elbow, below the spiral groove, and above the spiral groove.

Needle EMG is used to differentiate among posterior interosseus neuropathy, radial neuropathy at the spiral groove, radial neuropathy in the axilla, a posterior cord lesion, C7 radiculopathy, and a central lesion. Muscle selection often includes the triceps, brachioradialis, extensor carpi radialis, extensor digitorum communis, extensor carpi ulnaris, and extensor indicis proprius.

Nerve and skin biopsies to evaluate nerve damage are rarely needed.

Staging

Various grading systems have been used by physicians for classifying peripheral nerve injuries including the Seddon classification (1972) and the Sunderland classification (1978).

The Seddon classification groups nerve injuries into three categories.^[25]

1. Neuropraxia

Transient complete motor paralysis with minimal sensory involvement that commonly results from mechanical pressure. Spontaneous recovery often occurs when the offending pressure is removed.

2. Axonotmesis

More severe than neurapraxia and results from the disruption and loss of continuity of the axon with preservation of the supporting connective tissue structures including the endoneurium, perineurium, and epineurium. It is characterized by loss of both motor and sensory function. Complete recovery depends on removal of the insult and axon regeneration.

3. Neurotmesis

This is the most severe level of injury characterized by complete transection of the peripheral nerve leading to complete loss of sensory and motor function. Spontaneous recovery of function is unlikely and suboptimal without surgical intervention.

The Sunderland classification groups nerve injuries into five degrees. Grade 1 and grade 2 correspond to neurapraxia and axonotmesis, respectively. Grades 3, 4, and 5 correspond to increasing levels of neurotmesis severity. Grade 3 refers to loss of axonal and endoneurial continuity. Grade 4 involves loss of axonal, endoneural, and perineurial continuity. Grade 5 corresponds to loss of axonal, endoneurial, perineural, and epineural continuity.^[26]

Treatment & Management

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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.

Sections Radial Mononeuropathy
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Medication
Questions & Answers
References

Radial Mononeuropathy Workup

Imaging Studies

Laboratory Studies

Procedures

Staging

References

Tables

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