Radial Nerve Palsy By Hatlan alhatlan

211525898

Wrist Drop ??• Just Do It !!

Radial Nerve Anatomy

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.

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)

Clinical Presentation • Weakness of wrist dorsiflexion (ie, wrist drop)

and finger extension.Affected Site

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

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.

Also • Nerve conduction studies and needle

electromyography (EMG) (prognostic) are essential for specific localization and to rule out a more generalized process.

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.

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.

thanxxxx