Radial Mononeuropathy

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Background

Radial neuropathies result from injury due to penetrating wounds or fractures of the arm, compression, or ischemia. Most commonly, they present with a wrist drop. The pattern of clinical involvement is dependent on the level of injury.[1]

Radial neuropathies can occur from surgical procedures such as humeral nailing performed to stabilize an acute humeral fracture.[2]

The terms Saturday night palsy and honeymooner's palsy refer to the concept of placing one's arm over another chair, with the resultant pressure causing injury to the radial nerve.

Pathophysiology

An introduction to radial nerve anatomy is essential for understanding the common mechanisms and location of its injury. The radial nerve branches from the posterior cord of the brachial plexus. It receives root innervation from C5-T1 spinal roots. In the upper arm, the radial nerve gives off a branch to the triceps muscle before it wraps around the humerus at the spiral groove. Three sensory branches, which supply the skin over the triceps and posterior forearm, also are given off at this level. Here, its proximity to the humerus makes it susceptible to compression and/or trauma.

After exiting the spiral groove, the radial nerve supplies the brachioradialis muscle before dividing into the posterior interosseous branch and a sensory branch. The posterior interosseous branch is a pure motor nerve that supplies the supinator. It then dives into the supinator through the fascia to supply the muscles of the wrist and finger extension. This fascia is another common site for nerve damage to occur. The sensory branch that arises approximately at the elbow travels down the forearm, becoming superficial at the wrist before it supplies the lateral aspect of the dorsum of the hand. See the image below.



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

Epidemiology

Frequency

United States

Radial neuropathy is the fourth most common mononeuropathy.

Race

No racial preponderance is known.

Sex

No gender predilection has been observed.

Age

Radial neuropathy is reported in all age groups.

History

Symptoms are dependent on the site of the lesion.

Physical

Radial neuropathy typically presents with weakness of wrist dorsiflexion (ie, wrist drop) and finger extension.

Causes

See the list below:

Imaging Studies

See the list below:

Other Tests

Nerve conduction studies and needle electromyography (EMG) are essential for specific localization and to rule out a more generalized process.

Medical Care

Therapy is dependent on the site and cause of the lesion.

Surgical Care

Surgical exploration may be considered for a chronic compressive lesion or transection.

Consultations

Electrodiagnostic consultation is important in radial mononeuropathy in order to:

Medication Summary

Although no medications are specifically designed for radial mononeuropathy, in cases of neuropathic pain related to the neuropathy, various agents that may help reduce neuropathic pain should be considered.

Further Outpatient Care

Physical therapy may accelerate improvement after tendon transfer for irreversible radial nerve injury.

Prognosis

See the list below:

Patient Education

In patients with posterior interosseous lesions, discuss avoidance of repetitive supination of the forearm.

What is radial mononeuropathy?What is the pathophysiology of radial mononeuropathy?What is the prevalence of radial mononeuropathy in the US?What are the racial predilections of radial mononeuropathy?What are the sexual predilections of radial mononeuropathy?How does the prevalence of radial mononeuropathy vary by age?What are the signs and symptoms of radial mononeuropathy?Which physical findings are characteristic of radial mononeuropathy?What causes radial mononeuropathy?What are the differential diagnoses for Radial Mononeuropathy?What is the role of imaging studies in the evaluation of radial mononeuropathy?What is the role of nerve conduction studies and needle electromyography (EMG) in the evaluation of radial mononeuropathy?How is radial mononeuropathy treated?What is the role of surgery in the treatment of radial mononeuropathy?Which specialist consultations are beneficial to patients with radial mononeuropathy?What is the role of medications in the treatment of radial mononeuropathy?What is the role of physical therapy in the treatment of radial mononeuropathy?What is the prognosis of radial mononeuropathy?What is included in patient education about radial mononeuropathy?

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

Disclosure: Nothing to disclose.

Specialty Editors

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

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, MHA, CPE, 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; Chief Medical Officer, MeMD Inc; Chief Strategy Officer, Discourse LLC

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

Disclosure: Received research grant from: Lundebck pharma.

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

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