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Radial Nerve Injury

Radial nerve injury is a peripheral nerve injury affecting the nerve responsible for elbow, wrist, finger, and thumb extension, as well as sensation over part of the dorsum of the hand. It may occur due to humeral shaft fractures, compression, penetrating trauma, or iatrogenic injury. The classic presentation is wrist drop, with weakness of wrist and finger extension. Management depends on the level, cause, and severity of injury and may range from observation and splinting to nerve repair or tendon transfer.

Radial nerve injury may occur anywhere along the nerve’s course from the brachial plexus to its terminal branches and is commonly associated with humeral shaft fractures, prolonged compression, penetrating injuries, dislocations, and surgical procedures. The clinical features vary according to the level of injury and the branches involved. A high radial nerve lesion in the axilla may cause weakness of elbow extension, wrist extension, finger extension, and thumb extension, along with sensory loss over the posterior arm, forearm, and dorsolateral hand. Injuries at the spiral groove of the humerus usually spare triceps function but produce weakness of wrist and finger extension, resulting in the characteristic wrist drop. More distal lesions may selectively involve the posterior interosseous nerve, causing finger and thumb extension weakness without sensory loss, or the superficial radial nerve, producing predominantly sensory symptoms. Assessment includes careful motor and sensory examination, evaluation for associated fractures or soft-tissue injury, and serial documentation of recovery. Nerve conduction studies and electromyography may be useful in persistent or uncertain cases, particularly when recovery is delayed. Many closed radial nerve palsies, especially those associated with humeral shaft fractures, recover spontaneously and can initially be managed with observation, physiotherapy, range-of-motion exercises, and a wrist extension splint. Surgical exploration may be indicated in open injuries, suspected nerve transection, vascular injury, progressive neurological deficit, or failure of recovery when structural disruption is suspected. When primary nerve recovery is not possible, options include nerve repair, nerve grafting, nerve transfer, or tendon transfer. The goals of treatment are to restore useful wrist, finger, and thumb extension, maintain joint mobility, and prevent contractures while nerve recovery occurs.

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