Radial Nerve Palsy And Physiotherapy Treatment

Radial Nerve Palsy

Radial Nerve Injury, Physiotherapy Management

Radial nerve palsy, also known as radial neuropathy or Saturday night palsy, is a condition characterized by dysfunction or damage to the radial nerve, which controls movement and sensation in the back of the arm, forearm, and hand. This nerve originates from the brachial plexus in the neck and travels down the arm, branching out to supply various muscles and skin areas.

The most common causes of radial nerve palsy include trauma, such as fractures or dislocations of the humerus (upper arm bone), compression due to prolonged pressure on the nerve, or injury during surgical procedures. Symptoms typically include weakness or paralysis of the wrist, hand, and fingers, along with numbness or tingling sensations.

Treatment options vary depending on the severity and underlying cause of the condition, but may include physical therapy, splinting, medications for pain management, and in some cases, surgical intervention. Prognosis for radial nerve palsy depends on factors such as the extent of nerve damage and the timeliness of treatment initiation. Early diagnosis and appropriate management can often lead to significant recovery of function.

Introduction:

• Radial nerve is most commonly injured peripheral nerve accounting for 70% of all the peripheral nerve injuries of Upper Extremity.
• Wrist drop, also known as radial nerve palsy,
• it is a condition where a person cannot extend their wrist and it hangs flaccidly.
• your hand hang limply so that your fingers point downward.

Anatomy of Radial Nerve

The posterior cord of the brachial plexus gives rise to the radial nerve, which supplies the upper extremity. In addition, it supplies the wrist joint capsule, the dorsal skin of the forearm and hand, the triceps brachii muscle, and the muscles in the posterior compartment of the forearm (also referred to as the extensors).

The proper radial nerve innervates:

• Triceps
• Anconeus
• Extensor carpi radialis longus (ECRL)
• Extensor carpi radialis brevis (ECRB)
• Brachioradialis

The radial nerve splits into a superficial branch and a deep (primarily motor) branch that becomes the posterior interosseous nerve (PIN). 

The PIN innervates the following:

• Extensor digitorum
• Supinator muscle
• Extensor digiti minimi (EDM)
• Extensor carpi ulnaris (ECU)
• Abductor pollicis longus (APL)
• Extensor pollicis longus (EPL)
• Extensor pollicis brevis (EPB)
• Extensor indicis proprius (EIP)

Sensory innervation are:

• Posterior cutaneous nerve (arm and forearm)
• Superficial branch radial nerve (SBRN)
• Dorsal digital branch

The radial nerve and its motor and sensory functions can be rapidly evaluated with the following tests:

Motor function: Thumb extension against resistance is a motor function.

Sensory function: Two-point discrimination on the thumb's dorsum is a sensory function.

However, a comprehensive physical examination is always necessary. The signs and symptoms of radial nerve injuries vary depending on the location and nature of the injury.

Cause:

 

radial nerve injury has a variety of possible causes:

• fracturing the humerus (a bone in the upper arm)
• using crutches
• falling on or receiving a blow to the arm
• Saturday night syndrome
• compression of the lower part of the brachial plexus
• Awkward body positions: it can also put pressure on the nerve. For example, you sleep on your arm or leave it draped over the board.
• Growths: Tumors or cysts (lumps) inside your wrist or arm may press against the nerve.

Symptoms:

Injury to the radial nerve usually causes symptoms in the back of the hand, near the thumb, and in the index and middle fingers. Symptoms may include:

• sharp or burning pain
• numbness or tingling
• trouble moving the wrist and fingers
• analgesic or anti-inflammatory medications
• anti-seizure medications or tricyclic antidepressants
• steroid injection.
• Pinch and grasp problems: You may not be able to bring your thumb and fingers together (pinch) to grasp objects.

History:

A patient with ipsilateral (normal) hand radial neuropathy may present with the affected extremity held in that hand. He or she may report being unable to extend their wrist, thumb, and fingers, as well as having diminished or absent sensation on the dorsoradial side of their hand and wrist. 

It may appear that hand function is normal when the hand is supinated and the extensors are assisted by gravity. The wrist and hand will drop, though, if the hand is pronated. Another name for this is "wrist drop."

The forearm, hand, and fingers will not be able to extend if the axilla is injured. Thus, upon physical examination, this typically manifests as a wrist drop. The lateral arm will experience a loss of sensation.

Additionally, there will be a loss of sensation in the posterior region of the forearm, which will radiate to the back of the hand and fingers. This is frequently observed with "Saturday night palsy" and when crutches are used incorrectly (crutch palsy). The radial nerve may be impacted by any illness or clinical circumstance where the patient has compression in the axilla, incorrectly generated pathologic forces, or both through the brachial plexus.

Diagnosis:

• X-rays: You may need x-rays to check for broken bones or foreign objects in your arm.

• MRI. An MRI may be used to look at the soft tissues and blood vessels in your arm, and to check for cysts or masses.

• Electromyography and nerve conduction studies: these are tests that measure the electrical activity of your muscles. Your muscles are tested at rest and while you are using them. An EMG test may also check the nerves that control your muscles.

X-Ray Shows Fracture Of  Shaft Humerus With Radial Nerve Palsy

Treatment:

Wrist Drops Treatment

the symptoms of wrist drop will most likely resolve spontaneously within 8–12 weeks.

• Medical management:- pain relief drugs.
• Surgical Management:- to repair radial nerve, Tendon transfer

Physiotherapy Treatment
    

Physiotherapy treatment are mostly depends upon assessment of the patient.

Your Physiotherapist take your Physical examination and according treatment are carried out.

Most common form of treatment mainly are Electrical stimulation to the muscles which are associated with radial nerve.

Muscle strengthening exercise of weak or Paralyzed muscles.

If pain is associated Transcutaneous electrical nerve stimulation  (TENS) for pain relief

Splint or cast: You may need a splint or cast to help support your wrist and hand while the radial nerve heals. A splint or cast helps extend your fingers and wrist so you can use them as much as possible.

Splint in Radial Nerve Palsy

Physical therapy helps you with special exercises. These exercises help make your bones and muscles strong and flexible.

Wrist Joint Muscle Active Exercise

• Ball Squeeze
• Finger Stretch With Resistance
• forearm Rotations
• Wrist Stretch

Complications: 

Following treatment, a large number of patients with radial nerve palsy experience full recovery or symptom relief.

Complications in certain situations could include:

Partial or total loss of sensation in the hand: Numbness may last a lifetime if the radial nerve doesn't heal all the way.

Partial or total loss of wrist or hand movement: Weakness may last a lifetime if the radial nerve doesn't heal all the way.

Mild-to-severe hand deformities: Prolonged radial nerve impairments can result in atrophy of the muscles and joints as well as stiffness.

Repeated or undetected injuries to the hand or wrist: A person may not notice an injury if their hand or wrist are numb.