5th year At Medical School

1. Radial Nerve Palsy
By Hatlan alhatlan
211525898

2. Wrist Drop??
• Just Do It !!

3. Radial Nerve Anatomy

4. Causes
• Penetrating trauma can cause injury anywhere along the
nerve.
• Compressive lesions high in the axilla can occur from
improper use of crutches.
• Compression injuries at the humeral spiral groove occur
in patients with sustained compression of this area over
a period of several hours.(drunken – wheelchair)
• Subluxation of the radius can produce radial nerve injury
in the proximal forearm.
• Isolated distal sensory radial neuropathy is associated
with compression from handcuffs and tight bracelets.
• Bilateral radial palsies suggest lead intoxication.

5. Symptoms
Symptoms are dependent on the site of the
lesion:
• The most common reported symptom is wrist
drop.
• Above elbow numbness in forearm+hand.
• In the forearm wrist drop only (no parasthesia)
• In the wrist sensory changes and
paresthesias only in back of hand (no motor weakness)

6. Clinical Presentation
• Weakness of wrist dorsiflexion (ie, wrist drop)
and finger extension.
AffectedSite
all radial-innervated muscles are
involved.
Decreased sensation
Axilla
all radial-innervated muscles distal
to the triceps are weak
Spiral Groove
sensation is spared and motor
involvement occurs in radial
muscles distal to the supinator
Isolated Posterior Interosseous
Lesions

7. Investigations
• US localization.
• Imaging to show if any compression to the
nerve.
• X-Ray Fractures, dislocations, callus
formations, or osteophytes.
• MRI soft tissue evaluation and more direct
imaging of the nerve.

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

9. Treatment
• Medical Care :
• External compression at spiral groove
remove the cause and conservative..
• Physical therapy and wrist splinting helps in
reestablishing functional use of the hand.
• Humeral fracture lesion careful reduction+ext.fixation
• Exploration if no recovery is noted within sev.mon
• Post. interosseous neuropathies, repetitive supination of
the forearm should be avoided.
• Distal sensory is always conservative.

10. Treatment
• Surgical care :Indicated for chronic compressive
lesion or transection.
• Surgical exploration release of the nerve from
tethered points in the forearm.
• EMG localization identify section involved
• If transaction is suspected conservative for months
to assure no nerve growth , if no regeneration go..
• Tendon transfer to allow finger and thumb
extension in the irreparebale cases.

11. thanxxxx