Radial neuropathy results from injury due to penetrating wounds or fractures of the arm, compression, or ischemia. Most commonly, they present with a wrist drop, which is the inability to extend the wrist upward when the hand is palm down. The pattern of clinical involvement is dependent on the level of injury. Radial neuropathy is not necessarily permanent. Peripheral nerve regeneration is an imperfect and slow process and full restoration of ability may take months, years, or may never occur.
Instructions
1. Knowledge of radial nerve anatomy is essential for understanding the common mechanisms and location of its injury. The radial nerve branches from the posterior cord of the brachial plexus. It receives root innervation from C5-T1 spinal roots. In the upper arm, the radial nerve gives off a branch to the triceps muscle before it wraps around the humerus at the spiral groove. Three sensory branches, which supply the skin over the triceps and posterior forearm, also are given off at this level. Here, its proximity to the humerus makes it susceptible to compression and/or trauma.After exiting the spiral groove, the radial nerve supplies the brachioradialis muscle before dividing into the posterior interosseous branch and a sensory branch. The posterior interosseous branch is a pure motor nerve that supplies the supinator. It then dives into the supinator through the fascia to supply the muscles of wrist and finger extension. This fascia is another common site for nerve damage to occur. The sensory branch that arises approximately at the elbow travels down the forearm, becoming superficial at the wrist before it supplies the lateral aspect of the dorsum of the hand.
2. The nerve and its functions usually recover over a time-frame, which can vary from days to longer than a year. Faster recoveries mean that the nerve-fibers within the nerve-bundle were sick but not dead. In more severe injuries, the nerve-fibers at the site of the injury and beyond have actually died, and their surviving stumps need to send out sprouts to replace the missing parts. This is a very slow process. The growing sprouts reach the upper forearm, where the wrist-straightening muscles are located, before reaching the mid-forearm, where the finger-straightening muscles are located. Consequently, the muscles that straighten the wrist usually recover before those that straighten the fingers.
3. Understanding the realities of your condition, the progression of the symptoms and the immediate therapies and techniques to alleviate pain and maintain your own independence are the first steps in learning cope. One must also understand, through ones own investment of time, what works and does not work on an individual basis.
4. Develop an exercise regimen. In order to be useful, an exercise would need to focus on cocking up the wrist and straightening the fingers. However, until the damaged nerve-fibers reconnect with the muscle-fibers, the best exercise is a passive one that involves stretching out the weak muscles at least daily. Using passive "range-of-motion" exercises, people with nerve-injury can avoid shortening of tendons and freezing of joints that might otherwise occur as complications while waiting for the nerve to recover.
5. Watch your nutrition. Nerve-fibers need a good supply of nutrients. Healthy eating habits are paramount and supplemented by a multiple vitamin or two each day. This can give the nerve the building-blocks it needs to properly recover. Avoidance of alcohol might prevent a second injury. Alcohol can also produce a direct toxic effect on the body's peripheral nerves, therefore, abstinence would additionally prevent this barrier to recovery. In cases of prolonged weakness, electrical stimulation of the affected muscles via probes applied to the skin might keep the muscle-tissue healthier until they can receive more normal activation through their nerves.
6. While waiting for the nerve to heal, the wrist can be splinted in a neutral position with a device that leaves the fingers free to move. However, use of a splint does not preclude the need for at least daily, passive, range-of-motion exercises.
7. Understand your medications. There is generally a great deal of confusion in obtaining information on prescription medications and it overwhelms many patients. Most often the information obtained tends to be almost cryptic with all of the medical jargon. The best sources of information are reference books and online guides written for the general public. These guides describe in layman’s language what a drug is used for, take it, and what to do if you miss a dose. The guides typically give warnings, list side effects and describe how a drug might interact with other medications and herbal supplements. Plus, they sometimes give information not found on package inserts, as well as provide comparisons of one drug to another. Certain guides provide off-label drugs and uses not specifically approved by the FDA.
8. Join a support group. A support group is a valuable asset in learning about your radial neuropathy. For example, the Neuropathy Association, has well over 100 established groups across the U.S. that provide you with monthly meetings where you can meet and speak with others with the condition and peripheral neuropathy, hear medical professionals discuss various aspects of neuropathy, find knowledgeable doctors in the area, and ask questions that you might be unable to ask of people who do not have radial neuropathy. The support group gives you an opportunity to participate on committees that help the group function. If there is no support group in your area you might think of starting a new group and becoming a support group leader.
9. Use therapy and rebuilder devices. A rebuilder (http://www.rebuildermedical.com/) is a medical device that sends tiny electrical signals to nerves and muscles. It is FDA registered.Creams like capsaicin and L-Arginine have been used to reduce pain.
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