Radial Nerve Lesions/Compression

Background

  • The most frequent sites of compression are
    • the proximal forearm in the region of the supinator muscles, causing compression of the posterior interosseus nerve
    • a fractured humerus (between the middle and proximal thirds)

Anatomy of the radial nerve

Presentation

  • Radial nerve palsy (fractured humerus)
    • Weakness of the wrist and hand extensors, supination.
    • Numbness/paraesthesia over the dorsoradial aspect of the hand and radial 3 digits.
  • Radial tunnel syndrome
    • Pain over the anterolateral proximal forearm (over the radial neck- usually >5cm distal to the lateral epicondyle cf lateral epicondylitis), made worse by extension of the elbow and pronation
    • Weakness/numbness are usually late presentations
  • Posterior interosseus compression
    • Weakness of the extensors of the wrist/hand
    • Sensation usually preserved

Investigations and Management

  • X-ray if radial nerve palsy (particularly with a history of trauma)
  • Most diagnoses are clinical and do not require further testing.
  • Management is mostly conservative (where surgery for fracture e.g. in open fractures, is not indicated).

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