G56.31 Lesion of radial nerve, right upper limb
G56.32 Lesion of radial nerve, left upper limb
PREFERRED PRACTICE PATTERNS
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation1
5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury2
Patient is a 25-year-old female administrative assistant. She spends a significant amount of time utilizing the computer keyboard. She is reporting a burning pain in her dorsal forearm throughout the day depending on how much typing she has done. The pain is exacerbated by flexing her wrist down, typing, and lifting file folders in pronation. She denies any numbness/tingling into her distal extremity and only reports the local forearm pain. Functionally, she has to take frequent rest breaks throughout the day and when she becomes symptomatic her typing rate decreases as well. She is woken at night approximately 5 days per week especially when her hand drops off the edge of the bed into wrist flexion.
Clinically, she does not present with any sensory deficits. She does have a 10 lb grip strength decrease and reports pain with testing. Palpable tenderness in extensor mass 5 cm distal to lateral epicondyle. Increased symptoms with passive wrist flexion/ulnar deviation/elbow extension combination as well as resisted long finger extension and forearm supination. Positive neurodynamic testing with radial nerve bias.
Entrapment neuropathy of the radial nerve, particularly the posterior interosseous nerve (PIN) or dorsal radial sensory nerve (DRSN) in the elbow and wrist
Common entrapment sites include3:
Thickened fascial tissue superficial to radiocapitellar joint
Fibrous origin of extensor carpi radialis brevis (ECRB)
Radial recurrent vessels-leash of Henry
Proximal border of supinator-arcade of Frohse
Distal edge of supinator
Between tendons of brachioradialis and extensor carpi radialis longus (DRSN)
Subcutaneous tissue in distal forearm (DRSN)
Signs and symptoms typical of neuropathy, includes:
Symptoms are seen in the distribution of the radial nerve in the hand3, dorsal distal upper arm and dorsal forearm 4 to 5 cm distal to the lateral epicondyle
Burning or aching pain, paresthesias, and sensory loss perceived on dorsum of the forearm, thumb, and digits I–III dorsally; sensory changes only if DRSN syndrome
Rest pain and night pain are common3,4
In entrapment neuropathy, nerve becomes compressed, causing ischemic damage to the nerve.
Often associated with repetitive motions or sustained position of the elbow.
Unrelieved compression of the nerve results in ...
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