“I woke up with a pillow on my arm and my wrist stopped moving!”
This time, a physical therapist will explain the symptoms, causes, rehabilitation, and physical therapy sessions for radial nerve palsy that can occur in everyday life.
Four Points To Know about Radial Nerve
- It runs mainly through the back of the arm and spreads from the thumb to the middle finger at the tip of the hand.
- The radial nerve is the nerve that runs from the armpit through the arm to the hand.
- It controls the muscles that mainly bend the wrist toward the back of the hand and spread the fingers.
- It also controls sensation on the back of the arm and the back of the hand from the thumb to the middle finger.
There are two types of radial nerve palsy
Radial nerve palsy is divided into two types depending on where the nerve is damaged.
1- Radial nerve high paralysis
- Radial nerve palsy is often caused by activities of daily living.
- Even the radial nerve is damaged in the part that passes through the upper part from the elbow.
2- Posterior interosseous nerve palsy
- The posterior interosseous nerve branches from the thick part of the radial nerve at the tip of the elbow.
- Because this part passes through a narrow area covered with muscle, the nerve is pinched and prone to injury.
- Inflammation of the nerves, swellings called ganglia, fractures, and over-exercising can trigger the disorder.
Symptoms of Radial Nerve Palsy
Symptoms of radial nerve palsy vary depending on the type.
The table below shows the difference between each symptom.
|High radial nerve palsy
|Posterior interosseous nerve palsy
|・Unable to bend the wrist to the instep
・Unable to extend the base of all fingers
|-Unable to extend the base of all fingers
|sensation of being disturbed
|・The back side of the thumb, index finger, and middle finger and the thumb side of the wrist become dull or numb.
|– Often no sensory disturbance
Damage to the radial nerve causes the muscles controlled by the radial nerve to stop working, resulting in:
Inability to extend the dorsiflexion of the wrist and the joints at the base of the fingers (MP joints, metacarpophalangeal joints) (inability to extend). It is so called because the wrist and fingers are lowered. The first joint (DIP and IP) and the second joint (PIP) are extendable.
You can dorsiflex your wrist, but you won’t be able to extend the joint at the base of your fingers. It is called the drop finger because only the finger is in a downward position. If only the motor nerve called the posterior interosseous nerve is injured, there is no sensory abnormality.
Posterior interosseous nerve palsy can be distinguished from hyper-paralysis of the radial nerve because the muscles that move the wrist are not affected and only the drop finger is affected.
Disturbance of sensation is also a symptom of high radial nerve palsy. So, it is used as a criterion to determine which type of disorder it is.
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Causes of High Radial Nerve Palsy
High radial nerve palsy occurs when the nerve above the elbow is compressed or damaged.
Common causes include:
- Arm pillow
- Falling asleep after drinking alcohol
- Immobilization with a cast
It is also known as “Honeymoon Palsy” because it often happens as a result of sleeping on your arm all night on your honeymoon.
It is also called “Saturday Night Palsy” because it occurs when you sleep after drinking alcohol and put pressure on your arm for a long time.
In fact, you may have experienced difficulty opening your fingers or feeling numb after sleeping on your arm for a short period of time or with your arm facing down, but this is rarely a temporary symptom caused by compression of the radial nerve.
It may occur due to direct nerve damage due to bone fracture or surgery, and it may also occur due to compression due to cast fixation after surgery.
Causes of posterior interosseous nerve palsy
Since the posterior interosseous nerve is located relatively deep in the body from the surface of the body, it is difficult to cause paralysis due to compression such as high paralysis of the radial nerve.
Specific causes include:
- Excessive exercise
In this way, it is a disease that is often caused by some disease or trauma rather than simple nerve compression.
What is rehabilitation for radial nerve palsy?
Radial nerve palsy does not require surgery unless the cause is a fracture or the nerve has been severely damaged due to trauma.
Therefore, conservative treatment (treatment without surgery) including physical therapy is selected, and treatment is continued until the paralysis recovers. Therefore, we will explain specific treatment methods in conservative therapy.
- Rest is basic so as not to put a burden on the compressed nerve
- If the cause is nerve compression, rest is necessary so as not to strain the nerve.
- It is also recommended to cool the affected area if it is overly swollen.
- You can also take oral medications such as vitamin B12 to keep your nerves working properly.
Fixation to maintain correct posture
If the condition of the drooping hand or finger continues for a long time, the joints will harden, and tissues such as muscles and skin will contract, and even if the nerves recover, the movement of the wrist and fingers will not be possible. You run the risk of being restricted.
Therefore, it may fix the position of the wrist and fingers in the correct position.
Prosthetists, doctors, and physiotherapists who are specialists in prosthesis work together to create and fix joints in the correct position.
Carry out Physical Therapy According To Recovery From Radial Nerve Palsy
We will introduce three specific methods for each purpose of physical therapy for radial nerve palsy:
1. Prevents stiff joints caused by paralysis:
In order to prevent the joints from stiffening due to limited movement due to paralysis, exercises are performed to maintain the movement of the joints within a reasonable range.
Because it is difficult to move on your own with paralysis, the other hand is used to move the joint in different directions.
Rather than doing a specific number of times, you can secure a certain number of times by setting rules in your life.
For example, move it during TV commercials, move it when you wake up and before you go to bed, or move it while you are taking a bath.
2. Minimize muscle weakness
When the muscles do not work properly due to paralysis, the muscles become weak.
Especially if the duration of paralysis is long, the degree of muscle weakness is severe and recovery takes a long time.
However, even if you say that you will gain strength by yourself, you will not be able to move as you wish without being paralyzed.
In such cases, devices called low-frequency waves such as (Faradic) are used to contract the muscles to minimize muscle weakness.
Low frequency uses electrical stimulation to encourage muscle contraction.
Low-frequency treatment is performed by specialists at physical therapy clinics.
3. Devise a daily life that does not put a strain on your nerves
Radial nerve palsy is likely to be caused by pressure on the nerve, so it is important to devise ways to avoid pressure in daily life.
When sleeping, be careful not to put your arm down on the paralyzed side. Or put pressure on it with the back of a chair or an elbow rest.
If you think that your hands and fingers cannot move, do not judge yourself and immediately consult an orthopedic surgeon.
Radial nerve palsy usually heals spontaneously with conservative treatment if the damage to the nerve due to compression is not severe.
Therefore, it is important not to leave it alone or deal with it by self-judgment. But to have an early response and treatment by a specialist.
If you wake up in the morning and feel that you cannot move your hands or fingers, you should consult physical therapist for diagnosis. So, physical therapy for radial nerve palsy should be as soon as possible.