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Condition/Disorder Synonym

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  • Radial nerve palsy

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ICD-9-CM Code

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  • 354.3 Radial nerve lesion

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ICD-10-CM Codes

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  • G56.31 Lesion of radial nerve, right upper limb

  • G56.32 Lesion of radial nerve, left upper limb

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Preferred Practice Patterns

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Key Features

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Description

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  • Entrapment neuropathy of the radial nerve, particularly the posterior interosseous nerve (PIN) or dorsal radial sensory nerve (DRSN) in the elbow and wrist.

    • - DRSN compression is synonymous with Wartenberg's syndrome

  • 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, including

    • - Pain

    • - Paresthesias

    • - Loss of sensation

    • - Later loss of muscle function

  • 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.

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Essentials of Diagnosis

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  • 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

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General Considerations

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  • 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 neurapraxia with segmental demyelination;6 further ischemic damage results in axonotmesis and wallerian degeneration5,6

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Demographics

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  • Coexists with lateral epicondylitis in 5% of patients3

  • AINS is rare, accounting for less than 1% of upper extremity neuropathies7

  • Most common among people in their 5th decade of life7

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Clinical Findings

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Signs and Symptoms

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  • Burning/aching pain in dorsal forearm exacerbated by repetitive activity in forearm pronation with wrist flexion including:

    • - Using a screwdriver, typewriter, computer keyboard or during handwriting

  • Pain reported over anatomical snuff box and dorsal thumb

  • Grip strength weakness due to pain

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Functional Implications

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  • Pain with elbow and wrist movements

  • Difficulty with grasping and manipulation activities due to pain

  • Impaired sensation

  • Loss of grip strength in advanced cases (PIN)

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Possible Contributing Causes

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  • Repeated exposure to severe cold3

  • Genetic structural ...

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