Radial neuropathy

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Radial neuropathy
Other namesRadial mononeuropathy, Saturday night palsy
Gray818.png
The suprascapular, axillary, and radial nerves.
Specialty Neurology   OOjs UI icon edit-ltr-progressive.svg
Symptoms Wrist drop [1]
CausesBroken bone, Direct nerve injury [2]
Diagnostic method MRI, Ultrasound [3]
TreatmentCorticosteroid, Pain medication [2]

Radial neuropathy is a type of mononeuropathy which results from acute trauma to the radial nerve that extends the length of the arm. [3] It is known as transient paresthesia when sensation is temporarily abnormal. [4]

Contents

Signs and symptoms

Symptoms of radial neuropathy vary depending on the severity of the trauma; however, common symptoms may include wrist drop, numbness on the back of the hand and wrist, and inability to voluntarily straighten the fingers. Loss of wrist extension is due to loss of the ability to move of the posterior compartment of forearm muscles. [3] [1] In the event of lacerations to the wrist area the symptom would therefore be sensory. Additionally, depending on the type of trauma, other nerves may be affected such as the median nerve and axillary nerves. [5]

Causes

Radial Nerve - Anatomy, Innervation
Humerus - anterior view Humerus - anterior view.png
Humerus - anterior view

There are many ways to acquire radial nerve neuropathy, including: [6]

  • Upper arm - a fracture of the bone
  • Elbow - entrapment of the nerve
  • Wrist - elbow deformity and soft-tissue masses
  • Axilla - here the most common cause is compression. However, a dislocation of the humerus is a possible factor as well. It could also be due to brachial plexus compression.

Mechanism

The mechanism of radial neuropathy is such that it can cause focal demyelination and axonal degeneration. [7] These would be caused via laceration or compression of the nerve in question. [8]

Diagnosis

Radial neuropathy may be diagnosed using MRI, ultrasound, nerve conduction study or electromyography (EMG). [3]

Treatment

Hand tendons Hand anatomy.jpg
Hand tendons

The treatment and management of radial neuropathy can be achieved via the following methods: [3] [9] [10]

  • Tendon transfer (the origin remains the same but insertion is moved)

Prognosis

Radial neuropathy is not necessarily permanent, though there could be partial loss of movement or sensation. Complications include deformity of the hand in some individuals. [2] If the injury is axonal (the underlying nerve fiber itself is damaged), recovery may take months or years and full recovery may never occur. EMG and nerve conduction studies are typically performed to diagnose the extent and distribution of the damage, and to help with prognosis for recovery.[ medical citation needed ]. A compressive neuropraxia of the radial nerve (Saturday night palsy) takes between 2 and 12 weeks to recover. It is a common misunderstanding to attribute severe motor weakness of the hand lasting only minutes to hours to radial nerve neuropraxia [1]

Culture and society

There are a number of terms used to describe radial nerve injuries, which are dependent on the causation factor such as:

See also

Related Research Articles

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Carpal tunnel syndrome (CTS) is a nerve compression syndrome associated with the collected signs and symptoms of compression of the median nerve at the carpal tunnel in the wrist. Carpal tunnel syndrome is an idiopathic syndrome but there are environmental, and medical risk factors associated with the condition. CTS can affect both wrists.

<span class="mw-page-title-main">Median nerve</span> Nerve of the upper limb

The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.

<span class="mw-page-title-main">Wrist drop</span> Medical condition

Wrist drop is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.

<span class="mw-page-title-main">Peripheral neuropathy</span> Nervous system disease affecting nerves beyond the brain and spinal cord

Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerve fibers are affected. Neuropathies affecting motor, sensory, or autonomic nerve fibers result in different symptoms. More than one type of fiber may be affected simultaneously. Peripheral neuropathy may be acute or chronic, and may be reversible or permanent.

<span class="mw-page-title-main">Thoracic outlet syndrome</span> Compression of the nerves or blood vessels between the neck and ribcage

Thoracic outlet syndrome (TOS) is a condition in which there is compression of the nerves, arteries, or veins in the superior thoracic aperture, the passageway from the lower neck to the armpit, also known as the thoracic outlet. There are three main types: neurogenic, venous, and arterial. The neurogenic type is the most common and presents with pain, weakness, paraesthesia, and occasionally loss of muscle at the base of the thumb. The venous type results in swelling, pain, and possibly a bluish coloration of the arm. The arterial type results in pain, coldness, and pallor of the arm.

<span class="mw-page-title-main">Polyneuropathy</span> Any disease affecting peripheral nerves on both sides of the body

Polyneuropathy is damage or disease affecting peripheral nerves in roughly the same areas on both sides of the body, featuring weakness, numbness, and burning pain. It usually begins in the hands and feet and may progress to the arms and legs and sometimes to other parts of the body where it may affect the autonomic nervous system. It may be acute or chronic. A number of different disorders may cause polyneuropathy, including diabetes and some types of Guillain–Barré syndrome.

<span class="mw-page-title-main">Peroneal nerve paralysis</span> Medical condition

Peroneal nerve paralysis is a paralysis on common fibular nerve that affects patient’s ability to lift the foot at the ankle. The condition was named after Friedrich Albert von Zenker. Peroneal nerve paralysis usually leads to neuromuscular disorder, peroneal nerve injury, or foot drop which can be symptoms of more serious disorders such as nerve compression. The origin of peroneal nerve palsy has been reported to be associated with musculoskeletal injury or isolated nerve traction and compression. Also it has been reported to be mass lesions and metabolic syndromes. Peroneal nerve is most commonly interrupted at the knee and possibly at the joint of hip and ankle. Most studies reported that about 30% of peroneal nerve palsy is followed from knee dislocations.

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<span class="mw-page-title-main">Ulnar tunnel syndrome</span> Medical condition

Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is ulnar neuropathy at the wrist where it passes through the ulnar tunnel. The most common presentation is a palsy of the deep motor branch of the ulnar nerve causing weakness of the interosseous muscles. Ulnar tunnel syndrome is usually caused by a ganglion cyst pressing on the ulnar nerve, other causes include traumas to the wrist and repetitive movements, but often the cause is unknown (idiopathic). Long distance bicycle rides are associated with transient alterations in ulnar nerve function. Sensory loss in the ring and small fingers is usually due to ulnar nerve entrapment at the cubital tunnel near the elbow, which is known as cubital tunnel syndrome, although it can uncommonly be due to compression at the wrist.

<span class="mw-page-title-main">Carpal tunnel</span> Structure of human wrist

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<span class="mw-page-title-main">Ulnar neuropathy at the elbow</span> Medical condition

Idiopathic ulnar neuropathy at the elbow is a condition where pressure on the ulnar nerve as it passes through the cubital tunnel causes ulnar neuropathy. The symptoms of neuropathy are paresthesia (tingling) and numbness primarily affecting the little finger and ring finger of the hand. Ulnar neuropathy can progress to weakness and atrophy of the muscles in the hand. Symptoms can be alleviated by the use of a splint to prevent the elbow from flexing while sleeping.

<span class="mw-page-title-main">Ulnar neuropathy</span> Medical condition

Ulnar neuropathy is a disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling. It may also cause weakness or paralysis of the muscles supplied by the nerve. Ulnar neuropathy may affect the elbow as cubital tunnel syndrome. At the wrist a similar neuropathy is ulnar tunnel syndrome.

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<span class="mw-page-title-main">Nerve compression syndrome</span> Human medical condition

Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by chronic, direct pressure on a peripheral nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression. Its symptoms include pain, tingling, numbness and muscle weakness. The symptoms affect just one particular part of the body, depending on which nerve is affected. The diagnosis is largely clinical and can be confirmed with diagnostic nerve blocks. Occasionally imaging and electrophysiology studies aid in the diagnosis. Timely diagnosis is important as untreated chronic nerve compression may cause permanent damage. A surgical nerve decompression can relieve pressure on the nerve but cannot always reverse the physiological changes that occurred before treatment. Nerve injury by a single episode of physical trauma is in one sense an acute compression neuropathy but is not usually included under this heading, as chronic compression takes a unique pathophysiological course.

<span class="mw-page-title-main">Holstein–Lewis fracture</span> Medical condition

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<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

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<span class="mw-page-title-main">Radial nerve dysfunction</span> Medical condition

Radial nerve dysfunction is a problem associated with the radial nerve resulting from injury consisting of acute trauma to the radial nerve. The damage has sensory consequences, as it interferes with the radial nerve's innervation of the skin of the posterior forearm, lateral three digits, and the dorsal surface of the lateral side of the palm. The damage also has motor consequences, as it interferes with the radial nerve's innervation of the muscles associated with the extension at the elbow, wrist, and fingers, as well the supination of the forearm. This type of injury can be difficult to localize, but relatively common, as many ordinary occurrences can lead to the injury and resulting mononeuropathy. One out of every ten patients with radial nerve dysfunction do so because of a fractured humerus.

Ischemic monomelic neuropathy(IMN) is an uncommon vascular access complication in hemodialysis patients that manifests as multiple mononeuropathies without clinical ischemia. Ischemic monomelic neuropathy is most likely to affect patients who have had brachiocephalic vascular grafts, and it is characterized by symptoms of acute pain, numbness, and paresthesia in addition to motor weakness. The term "ischemic monomelic neuropathy" was first used in 1983 by Wilbourn, despite the fact that Bolton et al. had originally reported on it in 1979.

References

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  2. 1 2 3 "Radial nerve dysfunction: MedlinePlus Medical Encyclopedia". medlineplus.gov. NIH. Retrieved 10 September 2016.
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  7. Wang, Jack T.; Medress, Zachary A.; Barres, Ben A. (9 January 2012). "Axon degeneration: Molecular mechanisms of a self-destruction pathway". The Journal of Cell Biology. 196 (1): 7–18. doi:10.1083/jcb.201108111. ISSN   0021-9525. PMC   3255986 . PMID   22232700 . Retrieved 10 September 2016.
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Further reading