Radial Nerve Palsy

The radial nerve originates from the posterior cord of the brachial plexus. A radial nerve injury results from acute trauma or compression of the radial nerve. This condition is often referred to as “Saturday Night Palsy” — as alcohol is sometimes a factor when a person falls asleep with the back of their arm compressed by the back of a chair, bar edge, etc; “Honeymoon Palsy” from another individual sleeping on one’s arm overnight, compressing the nerve; or “Crutch Palsy” — as this can occur due to compression on the nerve from walking with crutches.

The radial nerve supplies the extensor muscles allowing for extension of the wrist and fingers, in addition to supplying the triceps that extends the elbow. If the muscles are not working properly, the patient will experience the condition known as “wrist drop”. A radial nerve injury classically occurs by fractures involving the distal third of the humeral shaft. The patient will not be able to perform the “hitchhike” sign. If the nerve is compressed at the axilla, the triceps muscle will be affected. The patient will not be able to extend the elbow in addition to wrist drop.

Treatment for radial nerve palsy is usually a brace or cockup splint as well as physical therapy to help maintain muscle strength and to avoid contracture. EMG and nerve studies. The brachioradialis muscle is the first to recover and can be done as early as three weeks, but follow the progress. Nerve exploration is indicated in open humeral fractures with radial nerve palsy or in conditions that have had sufficient time without nerve recovery. A tendon transfer may be necessary if the nerve cannot be repaired or the function cannot be restored.