Radial Nerve Palsy

Abstract

Radial nerve palsy is caused by damage to the radial nerve, often because of a fracture of the humeral shaft or compression at the elbow. When evaluating a radial nerve palsy, it is important to determine whether the injury is to the radial nerve proper (high radial nerve palsy) or to the posterior interosseous nerve (low radial nerve palsy). Functional deficits associated with high radial nerve palsy include a loss of wrist extension, digital extension, and thumb extension/abduction, whereas in low radial nerve palsy wrist extension is spared. Many radial nerve palsies recover spontaneously and nerve surgery is not required. Surgery for radial nerve palsy is performed to release compression of the nerve, or to repair it with sutures or grafting. Tendon transfer is the most common surgical treatment for patients with radial nerve palsy. This article focuses specifically on the diagnosis and treatment of radial nerve paralysis, with special attention given to the use of tendon transfers to correct the secondary functional deficits associated with this condition. In addition, the controversy over the timing of surgical exploration for radial nerve palsies is addressed.

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