Radial Nerve Palsy 354.2

synonyms:

Radial Nerve Palsy ICD-9

• 354.2 (Lesion of radial nerve; acute radial nerve palsy)

Radial Nerve Palsy Etiology / Epidemiology / Natural History

• Majority of injuries associated with fractures are neuropraxias which will spontaneously recover.
• Associated with humeral shaft fractures: most recover in 3-4 months,     11.1% of closed fx have associated Radial nerve palsy, 0.2% in closed fx's fail to recover.  18% open fx. 60% have nerve entrapped in fx. (Bostman O, Acta Orthop Scand 1986;57:316) . (Shaz JJ, Bhatti NA: CORR 1983;172:171. (Holstein A JBJS 1963;458:1382).
• More commonly associated with distal third humeral shaft fractures and transverse or spinal patterns than middle or proximal third fractures or oblique or comminuted fractures. (Shao YC, JBJS 2005;87Br:1647).

Radial Nerve Palsy Anatomy

• Brachioradialis should be first muscle to return.

Radial Nerve Palsy Clinical Evaluation

Radial Nerve Palsy Xray / Diagnositc Tests

• EMG indicated at 6 wks if no signs of recovery.

Radial Nerve Palsy Classification / Treatment

• Initial: patients should be placed in cock-up wrist splint, given thumb abduction and finger/wrist extension exercises to avoid contracture. 
• If there is no sign of recovery clinically or on EMG at 4-6 months consider operative exploration. (Ekholm R, JBJS 2006;88Br:1469).
• CPT: 64722 (Decompression unspecified nerve)

Radial Nerve Palsy Associated Injuries / Differential Diagnosis

• Humeral shaft fracture
• Radial shaft fracture

Radial Nerve Palsy Complications

• Wrist / finger flexion contracture, loss of function

Radial Nerve Palsy Follow-up Care

• Mean time to onset of recovery is 7.3 weeks. Mean time to full recovery = 6.1 months. (Hak DJ, Orthopedics 2009;32:111)

Radial Nerve Palsy Review References

• Hak DJ, Orthopedics 2009;32:111
• Shao YC, JBJS 2005;87Br:1647

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