Radial Nerve Compression

Patients with radial nerve compression neuropathy may experience dorsum of the hand numbness, finger extension weakness, wrist dorsiflexion weakness as well as pain.  The radial nerve is responsible for supplying sensation on the dorsum of the hand and extension movement to fingers and wrist. It is the third most common upper extremity compression neuropathy, caused by excessive pressure on the nerve at one of its three compression sites:


  1. Radial tunnel syndrome

The most frequent radial nerve compression site is due to excessive pressure of tissues surrounding the posterior interosseus nerve (PIN).  It is mainly characterized by pain located over the proximal outer forearm and can easily be provoked by targeted physical exam. Even experienced medical providers often mistake radial tunnel syndrome for “Tennis elbow.” In advanced cases, pins and needles or numbness of the back of the hand, weakness of finger extension, and even weakness of wrist extension can be present.  This condition is common in people who perform repetitive wrist and hand motions, but can also follow surgery or trauma to the upper extremity.


Diabetic patients, due to abnormal glucose cell metabolism, over time may develop swelling of the nerve, as well as narrowing of the tunnel itself. This alters the normally perfect relationship between the nerve and its tunnel, resulting in radial nerve neuropathy. Therefore, diabetic patients are at much higher risk for experiencing symptoms of radial nerve neuropathy than the rest of the population.  (Radial tunnel syndrome is about three times more common in diabetics than in the general population.)  Numbness of the fingers in diabetics that is present despite good blood glucose control requires evaluation by a peripheral nerve surgeon, and early surgical treatment before the nerve is irreversibly damaged.  Radial Tunnel Syndrome can be treated and reversed with surgery, if treated in a timely manner.


Radial nerve compression at upper mid arm most commonly is a result of trauma (such as a humeral fracture) or surgical interventions addressing the fracture. Patients who have consumed excessive amounts of alcohol and slept malpositioned with their arm hanging over the edge of the bed all night may also develop this condition, giving It the monicker of  “Saturday night palsy”.  However, this “palsy” can also develop in patients who do not drink if their arms are left poorly positioned and they are unable to protect themselves, such as may occur during long surgeries, coma, or prolonged intensive care unit (ICU) stays.  The condition is due to direct pressure on the radial nerve as it crosses the unyielding surface of the humerus (upper arm) bone.  In addition to pain, these patients can develop rather acute wrist drop and/or inability to extend fingers, often mixed with various degrees of dorsal hand numbness.


The radial sensory nerve (RSN) is prone to compression as it emerges in the mid antero-lateral forearm on its way to provide sensory innervation to the back of the hand and first three fingers. Compression neuropathy at this site causes pins and needles or numbness throughout the territory of the RSN: mainly the ‘thumb’ side of the back of the hand. It can follow traumas, be present in diabetics or, similar to radial tunnel syndrome, can be a result of traction-stretch injures due to often and forceful axial pull on the extremity.


You should see Dr. Ducic for radial nerve neuropathy if your symptoms persist:

•Despite the medical care prescribed to you by your physician

•Despite supportive medical care, such as activity and work adjustments

•After three months of prescribed medical and conservative care

•Despite good medical diabetic care

•If you had surgery for a different, non-nerve related problem that was complicated by an acute radial nerve functional loss (numbness, weakness or pain), timely evaluation and intervention within 6 or (at the most) 12 weeks after its onset is critical to maximize the likelihood of a positive outcome. Restoration of nerve function may be significantly reduced if decompression is done after 3 months from neuropathy onset. This is unfortunately often overlooked by many who instead choose physical therapy and a “let’s wait and see” approach.


Surgical Treatment for Radial Nerve Neuropathy

If symptoms continue to be present despite a reasonable observation period (>6-12 weeks) and conservative, supportive care and physical therapy, than you can see me for evaluation for possible surgical treatment. The success of the surgery depends on how long the nerve has been compressed, the severity of the compression, the extent of nerve damage due to injury and possible presence of underlying medical or spine problems. I use advanced, minimally invasive techniques that spare other nerves in the hand and wrist. Advantages of using a minimally invasive approach include a quicker recovery, reduced possibility of infection and faster return to full function of the affected hand. In addition, a shorter scar is aesthetically better appealing to all.


Based on which of the three aforementioned compression sites or their combination is identified; surgical treatment is aimed towards your symptomatic sites (anatomical cause of the neuropathy).


I often perform revision surgeries, which address continued neuropathy following previous surgery in patients who failed to get relief after procedures performed elsewhere.


During Radial Nerve Surgery:

1.You will receive anesthesia so you won’t feel any pain during the surgery.

2.A small incision is made over one of the three radial nerve compression sites. Instead of making large incisions, special instruments are used to perform a minimally invasive approach. Fibrous tissues and bands pressing on the nerves are released to ease the pressure on the radial nerve; sometimes tissue around the nerve is removed if it is found to be abnormal. The skin is then closed in anatomical layers.

3.Radial nerve release is an outpatient procedure; your dressing will stay on for about a week, while the sutures are removed two to three weeks later.


If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.

 

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