Radial Nerve Palsy ,Recovering . Part II- Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video Part 2 educational video describing the condition known as radial nerve palsy.
Radial nerve palsy results from acute trauma or compression of the radial nerve. The radial nerve originates from the posterior cord of the brachial plexus.
Injury to the radial nerve affects the functions of the wrist and fingers differently depending on the area of injury.
The radial nerve supplies the extensor muscles allowing for extension of the wrist and fingers. Injury to the nerve will cause wrist drop.
High radial nerve injuries usually occurs due to fractures of the distal third of the humeral shaft. The fracture may cause injury to the radial nerve causing paralysis of the wrist and finger extensors. The patient will be unable to perform the “hitch hike “ sign.
Low radial nerve injury usually occurs around the elbow, affecting finger and thumb extension.
A high lesion above the brachioradialis nerve causes wrist drop and loss of finger extension.
In patients with radial nerve palsy, recovery of wrist and finger extension is estimated to be about 1 mm per day. The brachioradialis muscle is the first to recover.
Treatment
•Explore in open humeral fractures
•Observation in closed fracture
•Order EMG and nerve studies 3 weeks after the injury
•The brachioradialis muscle is the first muscle to recover
•Repeat EMG if necessary.
•Radial nerve recovery occurs in about 85% of the cases in about 4-5 months.
•Explore the nerve if there is no recovery
•Tendon transfer may be needed if there are no signs of radial nerve recovery.
•Pronator teres to extensor carpi radialis brevis is a basic transfer
•Splint the wrist in cock up position and order physiotherapy.
The nascent (just born ) polyphasic motor unit activity is the early evidence of nerve regeneration.
Bad prognosis: small polyphasic motor unit 6 months after injury.
Good prognosis: no P wave, no fibrillation in 3 weeks after injury.
Example of a patient recovering completely from radial nerve injury. With improvement od the injury, the patient will also be able to perform the “hitch hike” sign.
Example of a patient partially recovering from radial nerve injury. Recovery of the wrist extensors, but finger extensors are not yet recovered.
Patient example- the radial nerve is not yet recovered but appears recovers. The patient appears to have finger extension. This is an inaccurate examination.
With the wrist placed in extension, the patient cannot extend the fingers = the radial nerve did not recover.

[akashsidhu]

I recovered in 5-6 months, , got muscle stimulation machine at home and do physiotherapy daily, , even started going to gym by holding the wrist with wrist holder and pumping the muscles with light weight dumbles, it helped a lot, , now i am perfectly fine. Just don’t loose hope, , it feels like that it’s never gonna be ok but it will be good after some time. Keep in mind the recovery process is very slow, , but it do recover.

[kanthirekha]

Whoever is reading this, trust me when I say it will get better. I met with an accident 4 months ago and it was bad open fracture I couldn’t raise my thumb or my wrist. The doctors said that my radial nerve was probably stretched and it would take up-to a year to get my functionality back. I was doing my physio every day and after 2 months I could raise my thumb and within 2 weeks I was able to raise my wrist. I remember watching this video after the accident and thinking if I will ever get it back but I did so don’t loose your hope

[nelpark]

hi guys im feel so sad when i have fracture in my forearm and i cannot able to move my hands and fingers, but after reading all your comments and improvements i feel much better bec. my hands is started recovering after 3 weeks of my operation.. and im glad to see this video.. ty

[murtuzakhan]

I met with an accident on 30th July 2023, broke my 3rd distal humeral shaft right above elbow. Had to go through surgery and doctor added plate on it. Have been suffering from Radial Nerve Palsy with complete wrist and fingers down. It's been 19 days to my surgery. Today is 20th August 2023. I don't know when it will recover but I have firm belief in almighty Allah that it will return in sha Allah. After reading all your comments, my hopes are high and I will definitely keep others posted too on my recovery in sha Allah.

[venkateshiyer]

Hi I had suffering for 5 months exactly.Then my wrist recovered(after 5 months)Now my fingers are partially recovering it takes time.Dont worry much.U all will recoverVenkatesh

[sparksonfire]

Hi, I damaged my radial nerve in january and had 100% recovery by May/June. I have been lifting weights regularly for the past 2 months with no problems. I thought at the time it would be like that for life and was so depressed, but it really does just heal extremely slowly. If you have noticed some sign of recovery 90% of the time it will heal completley as mine has. So hang in there and it will recover, also my finger extension took longer to recover than my wrist.

[Soooooooooooonicable]

guh. I fractured my humerus bone pretty badly in November. Had surgery two weeks ago and now I suffer from this. Nice to read these comments and see that you guys are recovering well. I hope I'm equally as fortunate. The thought of never being able to type with two hands or use a controller is horrifying. I can lift my wrist and fingers partially, so that's something I guess. I'd say the movement of the thumb is the hardest to control. There is also an annoying prickly sensation on the side of my thumb. I guess I should just be happy that I can actually FEEL my  thumb. Great video. Gave me some much needed hope.

[radialnervegirl]

Hi, I didn't see any movement in my wrist or fingers for six months. I went for an EMG after 5 & a half months.They told me there was no reactivation in the radial nerve.10 days later i had my first sign of movement. It started with a very slight movement in my wrist.Over the next few weeks&months, my wrist & finger movements came back.I still don't quite have full finger extension (now I am one year since my accident), but it is hardly noticeable.Be patient, it is frustrating but it will recover!

[georgemathew]

Thanks for sharing man. It's going on a month and a half and I am depressed and scared. Thanks for helping me have faith!

[ultimatenathanl]

The only good thing to come out of all this is that I'm pretty much ambidextrous now since I had to learn to do everything left handed

[johnscrippo]

I’m suffering this exact injury following a humerus fracture and op to fit a plate. Currently 8 weeks in with no change at all in movement of the wrist or fingers. Have been getting less hopeful that I’ll start to see any improvement but it’s positive to see the comments on here with recovery, even if it takes months!

[radialnervegirl]

Hi Aksh and others, just to let you know that now, two years after my original humerus fracture and radial nerve palsy, I am just about back to normal. Slight problem not being able to point with my index finger very well and occasionally I get a cramp in my hand, if I overuse it. Otherwise I mostly forget that I ever had six months without use of my right hand at all. So keep your spirits up, it DOES improve. 

[drrangaprasadbhat]

Awesome presentation. Sir, this indeed will be a high end resource for the both professionals & non-professional. Thanks for the sharing the hard work Sir.

[MihaiPinzariu]

now i can officialy give a thumb's up.. I'm 85-90% healed i cannot extend my index fully when i lift my wrist but i can perfom almost everything like before.Type, write, eat
Damaged on Dec 27th 2012 now today is 9th of august.I started to see signs of recovery around middle of april when i could lift my wrist just a little and finger recovery signs around middle of june.Hang in there guys.. We're all gonna make it somehow :)

[mordie]

It's very different depending on how the nerve in damaged, but since yours has started to come back, you can almost certainly count on full recovery within 4-5 months like the presenter of the video has stated. To compare, I have almost all sensation back yet motor function is only now starting to return. All I can say is get a good brace and try to forget about it, it will return in time.

[nikolamarinkovic]

i got this from falling asleep with my arm pressed against the side of a arm chair, thank you for demonstrating the signs of recovery, i can slighty lift my wrist and extend my fingers now but that isnt true signs of recovery. thank you so much

[radialnervegirl]

Hi there Aksh. I didn't have any treatment at all because I live on a small island with basic health care. So I just waited for it to get better and tried to get on with things as best I could. It's possible that it would have got better sooner with electric stimulation. The doctors told me it would take 12-18months for full healing (from the time of the break to full recovery) and I am on track for that. Keep positive, it will recover. Helen

[reynoldsc]

I'm so scared. It's been a week today since I had my injury. I'm getting a little better but I need full recovery since I have an office job and I'm required to type. Hopefully the doctors and Rehabilitation will get me back before pre-injury!

[saathiya]

UPDATE: since 29th Dec 2012 till today 29th July 2013, its been exact 7 months after Humerus fracture and radial nerve palsy and now I m almost 90% recovered. still cant extend my index finger fully but it always heal at the end. 1st sign of extension was in April and since its improving day be day. I can do almost everything normally now like right now typing :) and for those who are new comers of radial nerve palsy :) hang in there, it's irritating of course but its gonna be OK. It will heal

[GurunathHari]

Gurunath Hari
Very educational. Great job Dr. Ebraheim. Thank you. I trekked a set of mountains on 15 Feb 2020. Up and down 14 hours. Used a stout stick for assistance. After a day forearms sunburnt. After week and a half since 26 Feb I suspect I have mild to severe right radial palsy and milder left radial palsy. I have mold mild localized pain below the right elbow dorsally. My question: is that how long it takes for symptoms to manifest?