Definition

What is radial neuropathy?

The radial nerve is located behind the arm (triceps), wraps around the outside of the elbow (lateral epicondyle), and continues down the forearm to end on the top of the thumb and index fingers. The term “neuropathy” refers to abnormal nerve function that may occur when a nerve becomes constricted or compressed (entrapped) anywhere along its path.

How common is radial neuropathy?

Radial neuropathy commonly affects more males than females. It can affect patients at any age. Please discuss with your doctor for further information.

 

Symptoms

What are the symptoms of radial neuropathy?

The common symptoms of this condition are:

  • Pain
  • Weakness
  • Numbness
  • Tingling (paresthesia)

These symptoms may occur at the back (dorsum) of the forearm, as well as the dorsal hand, thumb, or fingers (index, middle, and part of the ring finger), but not usually at the fingertips.

Radial neuropathy (radial nerve entrapment) typically occurs at the back of the arm, at the elbow, or in the deep muscles of the forearm.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes radial neuropathy?

The most common causes of radial neuropathy are:

  • Direct trauma to the nerve or prolonged pressure on the nerve from compression, swelling, or injury of nearby structures.
  • A high radial nerve palsy is a compression of the radial nerve above the elbow, which may occur from inappropriately using crutches (crutch palsy) or from habitually resting the arm over the back of a chair.
  • The radial nerve may also become compressed in its spiral groove along the back of the humerus during a period of immobility such as occurs during deep sleep (Saturday night palsy).
  • Symptoms of aching at the elbow/forearm are often reported with work-related repetitive activity requiring significant pronation or supination of the forearm or ulnar wrist flexion (which stretches and therefore puts additional pressure on the radial nerve).
  • Symptoms have also been reported with using a screwdriver, prolonged writing with a pen, and using a typewriter (Dellon; Erlich).
  • Compression of the sensory portion of the radial nerve at the wrist (Wartenberg syndrome) may be caused by wearing a tight watch strap or from the application wrist bands.
  • Individuals with diabetes, rheumatoid arthritis, or hypothyroidism have increased likelihood of developing nerve entrapment syndromes.

Risk factors

What increases my risk for radial neuropathy?

There are many risk factors for this condition, such as:

  • Sex: Radial neuropathy is twice as likely to occur in men as in women.
  • Occupation: Force and repetition or force and posture
  • Alcohol abuse and tobacco use

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is radial neuropathy diagnosed?

History: The history of symptoms is dependent on the location (arm, forearm, wrist) of the radial nerve entrapment. Individuals may report sharp, burning, or aching pain in the lateral portion of the elbow, as well as along the back (dorsum) of the hand, thumb, or at the index, middle, and part of the ring fingers. Numbness or tingling may be present between the back of the thumb and index finger (first dorsal web space). Over time, individuals may notice progressive weakness, a lack of dexterity, and a feeling of fatigue with wrist and hand movements, and sometimes wrist drop, where the hand is unable to turn from a pronated (palm down) position to a supinated (palm up) position.

Physical exam: Again, the physical examination is dependent on the location (arm, forearm, wrist) of the radial nerve entrapment. On physical exam, the individual may be unable to extend the elbow, wrist (wrist drop), thumb, or fingers (finger drop), and may have difficulty rotating the palm up. Extension with radial deviation but no finger extension localizes the site of compression to the radial tunnel. There may be tenderness to palpation of the radial tunnel region at the front of the elbow distal to the lateral epicondyle, and there may be pain upon resisted wrist extension, index finger extension, or forearm supination. In mild cases, weakness is most likely to be detected by resisting the extended index finger, or resisting supination in the pronated position. If symptoms originate from the elbow, tapping (percussion) over the radial nerve at the radial tunnel may reveal a localized Tinel’s sign (tingling sensation); however, this does not always occur.

Tests: Electromyography (EMG) and nerve conduction studies may help to establish the diagnosis of nerve entrapment, although results are often inconclusive in early mild cases. X-rays may be performed to rule out bony abnormalities that may contribute to nerve compression. If a mass is suspected as the cause of radial nerve compression, an MRI may be obtained for confirmation. A lidocaine injection (nerve block) may be administered to evaluate the presence of nerve entrapment.

How is radial neuropathy treated?

Treatment of radial neuropathy (radial nerve entrapment) depends upon the underlying cause and location of the nerve compression or entrapment. Application of a neutral position wrist splint can help to rest the affected area and limit irritation to the radial nerve.

Symptoms may be controlled by over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), or with a corticosteroid injection to reduce local inflammation and swelling around the nerve.

Physical therapy may be prescribed to stretch tight soft tissues compressing the nerve and to strengthen surrounding muscles. Other non-pharmaceutical treatments, including transcutaneous electric nerve stimulation and acupuncture, may be considered as adjuvant to medication. A tennis elbow strap, commonly used for lateral epicondylitis, can sometimes aggravate symptoms of radial tunnel syndrome at the elbow.

For individuals that fail conservative treatment, surgical decompression may be indicated. Examples include progressive weakness in grip strength or wrist/finger extension strength coupled with an abnormal electrodiagnostic study, or if imaging studies reveal that a structure (i.e., bone, tight muscle or tendon, cyst, tumor) is constricting the nerve. Surgery may be performed under a general or regional anesthesia. During surgery, the radial tunnel is enlarged by dividing the forearm fascia and surrounding tight muscle fibers, including division of the supinator muscle, allowing exposure of the posterior interosseous nerve. Any space-occupying lesions are located and removed, and the incision is closed with sutures and allowed to heal.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage radial neuropathy?

The following lifestyles and home remedies might help you cope with radial neuropathy:

  • Exercising regularly to reduce cramps, improve muscle strength, prevent muscle atrophy, and help control blood glucose levels
  • Eating a healthy diet to correct nutritional deficiencies and improve gastrointestinal symptoms
  • Quitting smoking, which can affect blood circulation and worsen neuropathic symptoms
  • Avoiding body positions that put prolonged pressure on certain nerves, such as keeping the knees crossed
  • Stimulating the nerves and improving circulation by massaging problematic areas associated with neuropathy, such as the feet and legs

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: September 5, 2017 | Last Modified: September 5, 2017

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