BY ANUJA.C

The radial nerve is a continuation of posterior cord of brachial plexus in the axilla. It is a largest branch of the brachial plexus It supplies the posterior(extensor) compartment of upper limb It carries fibres fromC5,C6,C7,C8,T1 of brachial plexus.

Radial nerve starts from upper arm and runs down the wrist and movement and sensation of the arm and hand.This nerve is responsible for extending and controls the ability to bend the wrist and finger backwards. Radial nerve injury is a condition which affects the radial nerve. Injury results in numbness,weakness,and difficulty in moving the wrist, hand or fingers.

SYMPTOMS Abnormal sensation in hand: Numbness Weakness Burning sensation along with pain in the hand. Difficulty in hand movements: Difficulty straightening the arm Difficulty bending the wrist Trouble turning the arm inwards

Wrist drop: This deformity occurs in case of severe injury and damage of radial nerve. Pinch and grasp problems: The thumb and fingers cannot come together to grasp objects. Muscle atrophy in the forearm.

CAUSES PHYSICAL TRAUMA:  Broken arm bone or fracture  Fall  Cut injuries INTENSE PRESSURE:  Sleeping in awkward position  Tightly worn wrist watch  Sports activities  Tumour inside wrist

LOCAL CAUSES: IN THE AXILLA:  Aneurysm of the axillary vessels  Crutch palsy IN THE SHOULDER:  Proximal humeral fracture  Shoulder dislocation

BETWEEN SPINAL GROOVE AND LATERAL EPICONDYLE:  Shaft fracture  Lateral epicondyle fracture of humerus  Penetrating and gunshot injuries

AT THE ELBOW  Posterior dislocation of elbow  Head of radius fracture  Monteggia fracture AT THE FOREARM  Fracture both bones of forearm  Penetrating or gunshot injuries

PERIPHERAL NERVE INJURY

Nerve injury secondary to compression or traction depends on the duration. Seddon has classified nerve injuries into three categories: 1 st degree:(Neuropraxia) No disruption of the nerve or its nerve Sheath occurs. transient episodes of motor paralysis with little or no sensory dysfunction. At most in low grade nerve injuries. The myelin sheath is compromised. Recovery should be complete.

2 nd degree (axonotmesis)-more severe +disruption of the axon but with maintenance of Schwann sheath. Motor, sensory, and autonomic paralysis results. 3 rd degree (Neurotmesis)-most serious injury. All components of the peripheral nerve are injured expect the perineurium and epineurium.

ENTRAPMENT NEUROPATHY Entrapment neuropathy or compression syndrome is a medical condition caused by direct pressure on a nerve.

Radial nerve entrapment is an compression can occur at any location with in the course of the nerve distribution The most frequent site of compression is at the Radial groove of the humerus (Saturdaynight palsy) Posterior interosseous nerve (Posterior interosseous nerve syndrome)

PATHOPHYSIOLOGY COMPRESSION NEURAL EDEMA AND DILATATION OF BLOOD VESSELS IMPAIRMENT OF SUPPLY ISCHEMIA PERSISTENT EDEMA| HYPOXIA DEFICIENCY OF VITAL NUTRIENTS ANOXIC DAMAGE ORGINAL COMPRESSION FUNCTIONAL IMPAIRMENT

POSTERIOR INTEROSSEOUS NERVE SYNDROME Posterior interosseous nerve syndrome is a compression of posterior interosseous nerve this may result in paresis or paralysis of thumb and extensor muscle,resulting in inability to extend the thumb and fingers ETIOLOGY RA Ganglion cyst

CLINICAL FEATURES Initially presents with dull ache in proximal forearm Later difficulty in extending the thumb and the fingers

RADIAL TUNNEL SYNDROME

RADIAL NERVE PALSY Radial nerve palsy is a result of compression of the radial nerve. That results in the paralysis of all extensor of the wrist and digits, forearm supinators. Numbness occurs on the dorsoradial aspect of the hand Loss of extension of fingers, thumb and wrist. Numbness over 1 st dorsal interosseous mucle.

WARTENBERG SYNDROME Compression of superficial sensory branch of the raial nerve COMPRESSION SITE--- between brachioradialis and ECRL SYMPTOMS: Pain Numbness DIAGNOSIS: Forceful forearm pronation for 60 seconds Tinel 's test over the nerve –pain felt on the top of the forearm.

Clinical features Paralysis and wasting of all the muscles innervated. Weakness of forearm extension and flexion-triceps and brachioradialis Paralysis of wrist extensors. Weakness of thumb abductor and extensor muscles. Sensory loss on the dorsum of hand and forearm.

Decreased ability to extend the arm.  Difficulty in lifting the wrist or fingers. Decreased ability to rotate the arm’ Muscle atrophy in the forearm. Weakness of the wrist and fingers. Wrist drop or finger drop

TEST FOR NERVE DYSFUNCTON EMG MRI of the head,neck,shoulder Nerve biopsy Nerve conduction tests

MANAGEMENT Pain medications Steroid injections Anesthetic creams Braces or splints Maintain muscle strength Massage Acupuncture TENS

PHYSICAL THERAPY Physical therapy is started in the early stages after nerve injury to maintain passive range of motion in the joints and to maintain muscle strength in the unaffected muscles. Splints may be used. ROM exercises. Correct positioning of a limb. Proper standing, sitting, sleeping postures.

SURGERY Tendon transfer