Radial nerve disease. Causes, signs and treatment of neuritis of the hand. Causes of radial nerve neuropathy

Hand movements and their sensitivity directly and indirectly depend on the human nervous system. Thus, the radial nerve is responsible for the flexion and extension of the hands and for the sensitivity of the skin in the area of the shoulder, forearm, the hand itself, as well as the back and upper side of the thumb. Damage to the radial nerve (neuritis, neuralgia or neuropathy) makes itself felt almost instantly, but first things first…

So, the radial nerve and its anatomy. The topographic anatomy of this nerve has a relatively complex structure, since, unlike other sections and branches of the nervous system, the radial nerve spreads along a given section in the form of a spiral, constantly bending and, as it were, entangling some of the muscles.

The structure of the radial nerve

The nerve is located in the shoulder joint and is the largest there. It has three branches:

From shoulder to chest.
From the shoulder to the armpit.
From the shoulder down the forearm to the hand.

The topography of the first segment is not as important as the second and third, since it is the last two branches that most often suffer from various lesions.

The presence of three branches (segments) does not mean the absence of other, smaller roots and rays. Thus, the radial nerve has the following important components:

articular branch (responsible for innervation of the shoulder joint);

Innervation is the main function of nerve endings, the transmission of impulses from the brain and back.

posterior cutaneous branch (responsible for innervation of the skin membrane of the back of the shoulder)
inferior lateral cutaneous branch (almost identical to the posterior cutaneous branch, but additionally responsible for innervation of the lower part and lateral part of the shoulder);
proximal branch, lateral branch and medial branch (responsible for the innervation of the triceps, ulnaris, radial and brachial muscles, which in turn pass near the radius and humerus);
posterior cutaneous branch of the forearm (responsible for the innervation of skin areas in the armpit area);
superficial branch (responsible for innervation of the back of the hand and middle finger);
deep branch (responsible for extension and flexion of the arm at the elbow joint).

Causes and risk factors

The radial nerve is the same component of the human body as, say, bones or muscles. It has a completely tangible structure, and you can even pick it up. And since it is a full member of the body, it means that it can simply be damaged or in any other way removed from a healthy state.

Some causes of radial nerve damage

How exactly can damage to the radial nerve be caused:

administration of the drug intramuscularly (especially if this procedure is performed by an incompetent specialist or a person who does not know how to give injections);
bruise or compression of the area of skin to which this nerve is adjacent (often this is the wall of the armpit);
inaccurate or incorrect use of hemostatic devices (tourniquets, etc.);
repeated bending of the elbows during fast walking, running, or other manipulations of the arms that require repeated bending of the arms;
nerve compression from being handcuffed;
bone fracture (damage to the nerve often occurs when a splinter hits it or when it is compressed by part of a broken bone);
forearm dislocation;
use of crutches;
infectious diseases (axonopathy may develop);

Axonopathy - inflammation of nerve processes

heavy metal deposits as a result of long-term use of medications;
tuberculosis;
diabetes;
vitamin B deficiency.

Symptoms - from “goosebumps” to “insensibility”

The nervous system and the nerve endings and branches themselves play an important connecting role. They connect the brain with the rest of the organs and parts of the body. A kind of electrical system in a modern car. Only in the event of a malfunction in the car, a certain sign lights up on the instrument panel; with the human body, everything is somewhat different. Damage to the nervous system can have two consequences:

Inability to transmit a nerve impulse.
The nerve impulse, and therefore the information (signal), is transmitted with distortions or incompletely.

Part of the nerve most susceptible to damage

Hence the lack of sensitivity (as an example, imagine a hose through which water flows; if you step on it, the water will flow worse, and the same with a nerve, if it is crushed, sensitivity will decrease due to numbness).

Signs of damage to the radial nerve will become noticeable to the patient almost immediately, since they are primarily associated with impaired motor functions.

Symptoms can begin from banal “pins and needles”, which grow over time and the pain from them intensifies, gradually developing into fever, to complete numbness of the limb or part of it.

As for disturbances in the motor functions of an arm or one of the arms (paresis, paralysis, etc.), they can manifest themselves as a result of a more serious lesion, at the level of the deep branches.

How to distinguish one form of damage from another?

In modern neurology, three concepts are distinguished, which in one way or another are associated with damage to individual nerves.

Neuropathy.
Neuralgia.
Neuritis.

Neuropathy is a phenomenon that results in damage to the entire nerve as a whole.

Neuritis - characterized by inflammation of nerve endings or roots (the prefix -itis means an inflammatory process, for example, encephalitis, meningitis, etc.)

The structure of the nerve in the hand

Neuralgia is a direct pain syndrome (either the entire nerve or a separate part of it).

Any neurologist will be able to distinguish these manifestations, since each of the terms has its own peculiarity and difference from the others.

Neuropathic disorder

Radial nerve neuropathy is not a rare disease, as it can occur in absolutely any healthy person, since the main cause of this manifestation is compression of the nerve canal or groove in which the nerve is located as a result of prolonged exposure to the same position.

In particular, head pressure on the hand during sleep (students or people intoxicated are often susceptible to this).

The main symptoms of neuropathy may be:

drooping of the right or left arm (in particular the hand);
combination of thumb and index finger;
difficulties in straightening the arm at the elbow joint, as well as in bending it;
goosebumps on the fingertips to the point of numbness.

Neuralgic lesion

Since neuralgia is a direct pain syndrome, with radial neuralgia the clinical picture manifests itself directly in pain of varying intensity. Most often, this occurs as a result of irritation of nerve fibers and segments in contact with other internal organs.

For example, as a result of compression or pinching of a nerve, it has to pass through narrow anatomical openings, which causes neuralgic pain.

Concentrating on this pain, the patient may not notice any other manifestations, including numbness and lack of sensitivity of the skin.

Neuralgia can develop as a concomitant symptom, as well as as an individual lesion.

Neuritis and its manifestations

Neuritis, as mentioned above, occurs due to inflammation of the right or left part of the radial nerve. This inflammation can develop as a result of infectious diseases, as well as as a result of nerve irritation due to injuries of varying severity.

The symptoms of neuritis are similar to neuropathy, and it is for this reason that these concepts are sometimes interchanged by neurologists, so as not to frighten patients with the abundance of terms.

Diagnostics

Despite the fact that the banal “rested hand” refers to damage to the radial nerve, even such a manifestation can drag on and end for the patient with excruciating pain in this “rested” hand, if, for example, the nerve has not returned to its original position, or God changed his usual location.

In order to eliminate the consequences and find out what the reason is, how serious and deep it is, it is necessary to carry out a comprehensive diagnosis, which includes:

Interview with a neurologist and neurological examination

radiography;
electromyography;
electroneurography;
Ultrasound of the arm or hands (depending on the nature of the injury);
CT scan.

Depending on the severity of the cause that caused the damage to this nerve, the following may be involved in the examination:

traumatologist;
orthopedist;
endocrinologist;
rheumatologist.

There are several simple tests that can be performed at home. For example, blockade of the radial nerve causes a phenomenon called “drop hand.” Recognizing it is quite simple; all you need to do is clench the affected limb into a fist, or try to shake hands. These actions will lead to drooping of the arm.

"Dangling hand" when shaking hands

The second test is to put two hands together in the gesture of a person praying. From this position, it is necessary to bend the fingers one by one. In the case of bending the palm along with the finger, we can talk about such a phenomenon as pinching of the radial nerve.

Treatment

Treatment for this disease can be divided into several types, which can be used both comprehensively and separately, depending on the severity of the cause that caused the disorder.

Treatment happens:

Conservative.
Surgical.
Treatment with folk remedies.

Usually, doctors limit themselves to a conservative type of treatment, since a course of medications in combination with preventive measures is enough to eliminate the symptoms of neuropathy.

Conservative therapy

Conservative treatment may include:

drug therapy;
massotherapy;
physical therapy (physical therapy);
physiotherapy;
conducting electrical stimulation;
manual therapy.

Drug therapy may vary depending on the cause.

For example, if the radial nerve has been damaged due to infection, a course of antibacterial and antiseptic drugs must be prescribed.

Naturally, non-steroidal medications are used to relieve inflammation.

The course of conservative treatment does not exceed two months. Usually, after the end of this period, if there are no prerequisites for recovery, surgical intervention is prescribed.

Surgery

Surgical intervention is carried out after two months if there are no results from medication and consists of either suturing the damaged nerve or removing the tumor that has formed at the site of the lesion (the groove where the nerve passes).

In order to suture a nerve or remove a tumor, the doctor must gain access to the nerve by exposing it in the shoulder or elsewhere (where the lesion was diagnosed).

In addition, the indication for surgical intervention is neurolysis or the condition of the limb after a fracture, when the nerve was affected by the bone.

Neurolysis - release of the nerve from scar tissue

Folk remedies

Treatment with folk remedies for damage to the radial nerve is also used and gives good results.

It is important to remember that not all inflammations and lesions can be treated with folk remedies, since ruptures or fractures of the limbs can only worsen the situation.

For treatment with folk remedies, the following are used:

Eleutherococcus root;
blue clay;
lemon;
sage;
Jerusalem artichoke;
oregano;
dates;
burdock;
carnation;
elecampane;
rosemary;
turpentine;
goat milk;
propolis.

Let's take a closer look at some of the listed methods.

Goat's milk - cotton wool or gauze soaked in goat's milk must be applied to the affected area for two minutes, five times a day, until the pain is relieved.

Propolis - a propolis-based tincture is prepared with alcohol. 100 grams of alcohol are mixed with 50 grams of propolis and left for 7 days, stirring occasionally. After 7 days, corn oil 1:5 is added to the strained tincture. The compress from this tincture must be made for 10 days.

Rosemary - rosemary leaves are poured with cold water and infused for 21 days. After which this tincture is used to wipe the sore spot.

Dates are the most delicious procedure. It consists of eating pitted dates for a month. Can be used with milk.

Lemon - You can use lemon peel as a night compress.

Forecast

The prognosis of brachiomuscular or other damage to the radial nerve directly depends on its nature. For example, post-traumatic symptoms from fractures can last about 3-4 weeks, depending on the severity and location.

Normal nerve compression during sleep goes away within 2–4 days, and with proper treatment, even within 24 hours.

So, lesions of the radial nerve are not always characterized by the usual “pins and needles” or numbness of the limb; sometimes they are pain syndromes that make themselves felt suddenly. You should not neglect such signals from the body, but it is better to immediately contact a specialist so as not to aggravate the situation. Take care of yourself and your loved ones.

The radial nerve is responsible for extension of the thumb and index finger, wrist and elbow joints, and rotation of the hand. Its trunk runs along the muscles, bones and ligaments. Damage to the radial nerve is caused by compression caused by compression of adjacent structures.

Neuropathy (neuritis, neuralgia), which occurs against the background of compression, disrupts the motor activity of the affected limb. Treatment tactics for inflammation of the radial nerve of the arm are selected taking into account the nature of the provoking factor.

Description of neuropathy

Compression-ischemic neuropathy of the radial nerve is one of the most common forms of this type of disorder. The occurrence of neuropathy is often associated with injuries to the upper extremities. The problem even occurs due to incorrect hand position during sleep.

The nature of the clinical picture of radial neuralgia is determined by the affected area. Disruption of the innervation of the fingers and the area on the palm side of the injured limb leads to the development of radial nerve palsy, in which a decrease or complete loss of sensitivity occurs. However, in this case, forearm extension is not impaired.

Carpal tunnel syndrome is diagnosed based on a comprehensive examination of the affected limb.

When selecting treatment methods, it is important to establish the presence of damage to the radial nerve, since a decrease in the sensitivity of the little finger and other fingers is often explained by impaired conductivity of other nerve fibers.

Anatomy of the radial nerve of the arm

To understand the structural features of the radial nerve that it innervates, it is necessary to consider its anatomy. Understanding the structure allows us to establish the relationship between damage to the upper extremities and accompanying symptoms (consequences of impaired innervation).

The radial nerve begins on the shoulder, passes along the posterior muscle wall, entering the triceps area, and affecting the local tendons. It is in this area where the radial nerve canal is located that damage most often occurs. The nerve then passes to the humerus. Here the head of the triceps muscles, together with the groove of the radial nerve, form the spiral (brachioradial) canal. Damage to the latter ranks second in the frequency of causes of neuralgia.

The spiral canal runs along the projection line of the axillary artery.

At the end, the nerve enters the elbow joint, where it divides into two parts. This part of the hand is also one of the most vulnerable in terms of the likelihood of developing neuralgia.

The radial nerve is divided into several branches, each of which is located in different areas:

Articular. It runs in the upper part of the forearm, reaching almost to the shoulder joint.
Rear. Lies close to the surface of the skin. The posterior radial nerve is responsible for innervation of the dorsum of the shoulder.
Lower side. It lies next to the previous one, entering the lateral and lower parts of the forearm.
Proxial, lateral and medial branches. Depending on the type of nerve fibers, they innervate the radialis, ulnaris, triceps and brachialis muscles.
Posterior, running along the forearm. Affects areas along the brachial and axillary canals. Characterized by strong branching of nerve fibers.
Superficial. Responsible for innervation of the back of the hands and the first three fingers.
Deep. It runs through the instep bone and ends on the inside of the forearm. The job of the deep branch of the radial nerve is to transmit sensation to the extensor muscles.

The maximum accumulation of nerve fibers is observed in the area of the armpit, the minimum number in the region of the third of the shoulder.

Causes of pinching

Neuralgia occurs due to:

prolonged lying (particularly during sleep) on your arm in an uncomfortable position;
applying a tourniquet to the arm to stop bleeding;
repeated and prolonged flexion of a limb (while running, conducting or when performing other actions);
wearing crutches or handcuffs.

Compression occurs in the presence of fibromas and other neoplasms that grow along the radial nerve canal. Post-traumatic neuritis is caused by fractures of the right humerus, head of the radius, dislocations and other injuries. The following diseases also lead to damage to the radial nerve:

Those at risk for developing neuralgia include pregnant women and people with hormonal imbalances. Less commonly, neuropathy occurs due to improper administration of a subcutaneous injection.

Symptoms

In case of radial nerve neuritis, symptoms are determined by the localization of compression or inflammatory process caused by infectious or other pathologies. In case of damage to the fibers located in the armpit, the following disorders are noted:

the forearm, hand and partially the phalanges of the fingers do not fully extend;
the thumb is not moved to the side;
when extending the left or right limb, the hand falls down, the thumb is pressed against the index finger;
the elbow extensor reflex disappears;
there is a decrease in the mobility of the forearm and hand when they are turned outward.

Inflammation of the radial nerve in the armpit area causes a decrease in the sensitivity of the first three fingers.

This part of the hand also experiences pins and needles, tingling, and burning sensations (a condition known as paresthesia). In advanced cases, muscle hypertrophy is detected in the affected area.

If the damage to the radial nerve is localized in the middle third of the forearm (in the area of the spiral canal), the patient is concerned about the following symptoms:

weakening of the extensor function of the forearm (the reflex remains);
a slight decrease in sensitivity in the shoulder area and complete loss of it on the back of the hand.

In case of damage to the radial nerve in the lower third of the shoulder and upper third of the forearm, as well as in the elbow, intense pain and paresthesia occur on the back of the hand. These symptoms bother you mainly when making movements of the limb. At the same time, there is a decrease in muscle tone in the forearm area while maintaining sensitivity in this area.

When the wrist is damaged, causing radial nerve neuropathy, symptoms manifest in the form of two syndromes: tunnel and Sudeck (Turner). The first develops due to compression of local fibers. The appearance of Sudeck's syndrome after a fracture of the radius of the arm provokes various symptoms, determined depending on the time period that has passed since the injury.

Initially, this condition is characterized by the following symptoms:

redness of the skin in the hand area;
edema;
burning or sharp pain in the hand.

Over time, the skin color in the affected area acquires a bluish tint. Due to impaired blood supply, the hand becomes cold. Sudeck syndrome causes numbness in the fingers (mostly the thumb). Uncontrollable twitching of the muscles in the affected hand is also possible.

In the absence of adequate treatment, Sudeck syndrome causes irreversible changes. Insufficient blood supply and damage to the radial nerve lead to muscle atrophy, which is externally manifested as a decrease in the size of the hand.

Diagnostics

To make a diagnosis of “neuropathy of the right radial nerve”, a comprehensive examination of the patient is necessary to identify the disorder and the causes of the pathology.

Neuritis is determined using special tests that evaluate functional changes that affect muscle performance. This will require knowledge of the topography of the radial nerve.

To assess the condition of the injured limb, the patient is asked to:

Stretch both upper limbs forward, keeping the hands in a horizontal position: the hand hangs down with neuritis.
Extend your arms along your body, turning your hands outward. With neuropathy this cannot be done.
Move your thumb to the side.
Bring your palms together and move your fingers away (fingers bend on the side of the problem area).

These tests make it possible to differentiate radial nerve neuropathy from other neurological disorders.

Help to determine the causes of the disorder:

Electroneuromyography (ENMG) is considered an important diagnostic procedure. Carrying out electrical stimulation for neuritis allows you to assess the degree of damage to the fibers. The results of the procedure show the speed at which the impulse travels through the nerves. To assess changes in the functional abilities of muscles, electromyography is prescribed.

CT, MRI and ultrasound of the radial nerves are performed to diagnose the causes of neuritis. If necessary, the patient is sent for consultation to an endocrinologist, traumatologist and other highly specialized doctors.

Treatment of neuralgia

After diagnosing a pinched radial nerve in the arm, treatment is carried out taking into account the nature of the lesion. Priority problems come to the fore when selecting a treatment regimen. In particular, drugs are first used to stop the inflammatory process and complications of toxic damage to the body, or other procedures are used to eliminate the consequences of a fracture or other severe injuries. In the latter case, limb immobilization and surgical intervention are more often used.

If neuralgia is caused by external factors, such as the use of crutches, you must stop using them for the duration of treatment. Treatment of neuropathy is usually carried out on an outpatient basis. More often, patients are admitted to the clinic if they require the administration of strong drugs or surgery for a fracture.

Drug therapy

Various medications are used to treat radial neuropathy. The basis of therapy is non-steroidal anti-inflammatory drugs: Ibuprofen, Diclofenac and others. Treatment of the radial nerve of the hand is complemented by antibiotics, which suppress the activity of the bacterial microflora that causes inflammation. At the same time, taking decongestant drugs such as Hydrocortisone or Diprospan is indicated.

Regardless of the cause, radial nerve palsy is treated with:

vasodilators that increase blood flow to the affected area;
anticholinesterase drugs that restore radial nerve conduction;
B vitamins that stimulate the regeneration of damaged tissues;
vasoactive drugs (nicotinic acid, Pentoxifylline) that normalize metabolism.

In case of acute poisoning of the body, detoxification is indicated, which is carried out using intravenous injections of glucose and sodium chloride solutions.

For endocrine disorders, hormonal drugs are prescribed.

In case of post-traumatic neuritis of the radial nerve of the hand, recovery after a fracture involves repositioning the bones and other procedures through which the previous skeletal structure is restored. Also, for such disorders, physiotherapeutic procedures are used: acupuncture, magnetic therapy, massage and others.

Treatment with folk remedies

In case of a violation of the innervation of the radial nerve with damage to the arm or hand, the use of traditional medicine is justified if drug treatment is carried out. Herbal preparations relieve only the symptoms, but do not eliminate either the cause of the development of neuropathy or the disorder itself.

Treatment of the radial nerve with folk remedies is carried out using:

Propolis. The product is used in the form of compresses. To prepare the medicinal composition you will need 40 grams of propolis and 100 ml of 96 percent alcohol. After mixing, the solution is infused in a dark place for a week. During this period, it is necessary to shake the composition regularly. At the end you need to add corn or olive oil in a 5:1 ratio. A compress with this remedy is applied for 10 days.
Red (pottery) clay. It must first be mixed with vinegar and rolled into a flat cake. The clay should then be applied to the problem area overnight for three days.
Raspberries. You will need a tablespoon of chopped stems and 250 ml of boiling water. The mixture is simmered over low heat for 5 minutes. Next, the product is infused for half an hour. It is recommended to drink the resulting composition three times a day half an hour before meals.

Damage to the radial nerve of the arm is treated with bear lard, which must be rubbed into the problem area for four weeks. A good effect is achieved by applying horseradish leaves to the hand. Also, treatment of the radial nerve can be supplemented with an infusion of fireweed tea (a tablespoon of the plant per 250 ml of boiling water, infused for 8 hours in a thermos).

Physiotherapy

For neuropathy of the radial nerve, a set of physical exercises is indicated, with the help of which the lost functions of the limb are restored. Exercise therapy is selected individually. Damage to the radial nerve can be eliminated using the following exercises:

Bend your arm at the elbow and rest your limb on a hard surface, maintaining a right angle between the support and your forearm. Thumb down, index finger up. Repeat the exercise 10 times.
Hand position as in exercise No. 1. Index finger down, middle finger up. Repeat the exercise 10 times.
Grasp the lower phalanges of four fingers with your healthy palm, leaving the thumb aside. Bend and straighten your palm 10 times. Grab the upper phalanges and repeat the steps. Finally, with your healthy hand, clench the fingers of the affected limb into a fist 10 times.

Treatment of a pinched nerve in the hand has a good effect if the patient performs the following exercises in water:

Press with healthy fingers on the phalanges of the patients, straightening them completely.
Extend the sore fingers or spread them to the sides with the healthy hand.
Raise and lower the sore fingers (except for the thumb), straightening the phalanges.
Make circular movements with each finger.
Place a towel on the bottom of the bathtub and squeeze it into a fist with your sore hand.

It is highly not recommended to perform the described exercises without consulting a doctor. Failure to comply with this rule can lead to serious consequences. Of particular danger are cases when the patient refuses to follow medical recommendations after nerve repair.

Massage for radial neuropathy

Neuropathy of the radial nerve of the hand is often accompanied by an inflammatory process in the problem area. To stop the latter, it is necessary to speed up blood circulation and restore metabolism. This can be achieved by performing massage for radial nerve neuritis.

The procedure is carried out no more than 15 times. It is forbidden to perform massage actions on your own, as this can cause serious injuries.

Forecast and recovery

The recovery time for the radial nerve of the arm takes on average 1 – 2 months. The duration of rehabilitation is determined by the patient’s age, the nature of the lesion and the characteristics of concomitant diseases. Post-traumatic neuropathy requires a longer recovery.

The prognosis for neuritis is mostly favorable. It is important to promptly begin treatment for a neurological disorder and follow medical recommendations.

To prevent neuropathy, you need to sleep in a comfortable position and give up bad habits. Persons whose profession involves frequent repetitive movements should regularly exercise and massage the upper extremities. It is also recommended to undergo a complete body examination every 6 months.

Radial neuropathies are the most common diseases of the peripheral nerves. They are usually provoked by prolonged compression, which leads to dysfunction of the nerve. And most patients describe their illness with the words “the arm rested.”

The radial nerve provides the following movements of the upper limb: extension at the wrist and elbow joints, extension of the phalanges of the I-III fingers, abduction of the thumb to the side, rotation of the hand. This nerve innervates the triceps muscle along the posterior surface of the shoulder, passes to the outer side of the forearm and ends on the back of the I-II and half of the III finger. Typically, compression of the radial nerve occurs in places where its nerve trunk passes near bones, fibrous parts of muscles and ligaments. Its compression causes disruption of the motor functions of the zones innervated by it and loss of sensitivity.

In this article, we will introduce you to the causes, symptoms and methods of diagnosing and treating radial nerve neuropathies. This information will help you suspect the development of this disease in time and begin its timely treatment.

Causes

The main reason for the development of radial nerve neuropathies is its compression. It can occur under different circumstances:

during deep sleep caused by fatigue or alcohol intoxication, when the hand lies under the head or under the body;
when scars appear in the intermuscular space along the radial nerve after strong blows;
with prolonged compression of the hand with a tourniquet;
prolonged pressure on the arm caused by crutches;
with a fracture of the humerus;
when performing an injection into the outer part of the shoulder (if the nerve is abnormally located).

Sometimes radial nerve neuropathies are provoked by the following conditions:

lead poisoning;
influenza, pneumonia, typhus and other infectious diseases;
hormonal disorders in women;
pregnancy;

Symptoms

The clinical picture of radial nerve neuropathies largely depends on the location of nerve compression.

First type

Nerve damage occurs in the armpit area. This type of radial neuropathy is rare and is called “crutch palsy.” It is characterized by the appearance of paralysis of the extensor muscles of the forearm, weakening of their flexion and atrophy of the triceps muscle.

The first type of radial nerve neuropathy is manifested by the following symptoms:

in an extended position of the arm, it becomes difficult to straighten the hand and the 1st-2nd fingers are clearly adjacent to each other;
when you try to raise your arm, your hand hangs down;
the extensor elbow reflex is impaired;
the sensitivity of the 1st-2nd finger is impaired;
sensations of numbness and paresthesia (tingling, sensory disturbances).

Second type

Damage to the nerve occurs due to its compression in the middle third of the shoulder (usually during sound sleep). Sometimes compression of the nerve in this area can occur due to prolonged fixation of the arm during anesthesia, use of a tourniquet to stop bleeding, a fracture of the humerus, or prolonged exposure to an uncomfortable position. In more rare cases, neuropathy is provoked by an injection into the outer surface of the shoulder, lead poisoning or infectious diseases (, etc.). This type of radial nerve neuropathies is observed more often than others, and this fact is explained by the fact that it is in this place that it bends around the humerus in a spiral (“spiral canal”, which is limited by the muscles of the shoulder and the humerus).

The second type of radial neuropathy is manifested by the following symptoms:

extension of the forearm is not impaired and the extensor reflex is preserved;
sensitivity in the shoulder area is not impaired;
there are no extension movements of the hand and fingers;
sensitivity on the back of the hand is lost.

Third type

The lesion occurs in the elbow area and is caused by compression of the posterior process of the radial nerve. It is caused by muscle overload or fractures of the humerus. This type of neuropathy is often observed in tennis athletes and is called tennis elbow syndrome. Due to degenerative changes in the area of attachment of the ligaments of the elbow joint and the extensor muscles of the hand and fingers, the disease becomes chronic.

The third type of radial neuropathy is manifested by the following symptoms:

pain in the extensor muscles of the forearm;
pain when bending and rotating the hand;
pain during active extension of the phalanges of the fingers against resistance;
severe pain in the upper forearm and elbow;
weakening and hypotrophy of the extensor muscles of the forearm.

Diagnostics

Data obtained from electroneuromyography make it possible to clarify the degree of damage to nerve fibers.

To make a diagnosis of radial nerve neuropathy, the following measures are taken:

the doctor finds out the events preceding the disease and listens to the patient’s complaints;
diagnostic tests are performed: press your palm to the surface of the table (with neuropathy it is impossible to press both fingers and palm at the same time), try to move your thumb away from your palm (with neuropathy it will press against your index finger), fold your palms in front of you (as for prayer) and try to spread them apart fingers (with neuropathy the fingers do not move apart);
Electroneuromyography is prescribed to determine the degree of damage to the radial nerve;
General clinical blood and urine tests are performed (general, biochemical, sugar).

Treatment

The treatment strategy for radial nerve neuropathy is determined by the cause of its occurrence and the location of the lesion. In case of infectious diseases or intoxications, they are treated with medication, and in case of fractures, limb immobilization and other measures are carried out to eliminate the injury. If the nerve is torn during fractures, surgery is performed to stitch it together.

If radial neuropathy is caused by external factors (sleeping in an uncomfortable position, using crutches, active muscle activity), then it is recommended to completely eliminate them during treatment. In most cases, patients with this disease are treated on an outpatient basis, and hospitalization is indicated only for those patients who require the administration of potent or narcotic analgesics.

Conservative therapy

The drug therapy plan may include the following drugs:

– to eliminate pain and inflammation;
decongestants – to eliminate swelling;
vasodilators - to increase blood flow and improve nutrition of the nerve and muscles;
anticholinesterase drugs - to improve the conduction of impulses along the nerve;
B vitamins and biostimulants - to accelerate nerve regeneration.

Drug treatment of radial nerve neuropathies must be complemented by physiotherapeutic procedures:

physiotherapy;
massage;
acupuncture;
electromyostimulation;
magnetic therapy;
electrophoresis with medicinal solutions;
ozokerite;
mud applications.

Physical therapy and massage are important in restoring the radial nerve and lost functions of the hand. The set of physical exercises should be selected individually, and the load should be increased gradually. A good result is obtained by using spring or rubber devices to develop joint movements and gymnastics in water.

An approximate set of exercises for therapeutic gymnastics

Bend your arm at the elbow and rest it on the table surface (the forearm should be at a right angle to the table). Place your thumb down and your index finger up. Perform such movements alternately 10 times.
Position your hand in the same way as for the first exercise. Lower your index finger down and raise your middle finger up. Perform such movements alternately 10 times.
Grasp the main phalanges of the four fingers with the fingers of your healthy hand (the thumb should be located on the side of the palm). Bend and straighten the main phalanges of the captured fingers with your healthy hand 10 times. Then grab the second phalanges and repeat the same movements 10 times. After this, with your healthy hand, clench the fingers of your affected hand into a fist and straighten them - repeat 10 times.

An approximate set of exercises for therapeutic gymnastics in water

Perform all exercises 10 times.

Press with your healthy hand on the middle phalanges of the fingers of the affected hand, achieving their full straightening.
Raise and lower each finger of the affected hand with the healthy hand.
Move each finger of the affected hand back with the healthy hand. Start movements with the thumb.
Perform circular movements with each finger in different directions.
Raise and lower 4 fingers (index-little finger) and at the same time straighten them in the area of the main phalanges.
Raise the hand with your healthy hand and lower it onto the edge of the palm (little finger down). After this, perform circular movements of the wrist joint clockwise and counterclockwise, holding the hand by the tips of the ring, middle and index fingers.
Place the brush vertically on the main phalanges of the fingers bent in the water. With your healthy hand, bend and straighten your fingers in each phalanx.
Place your hand with your fingers bent. Straighten them using springy movements.
Place a towel on the bottom of the bath. Trying to grab it and squeeze it in your hand.
Grasp rubber objects of different sizes (balls, rubber toys, etc.) with the affected hand and squeeze them.

Surgery

In rare cases, radial nerve neuropathy does not respond well to conservative treatment and the patient may be recommended to undergo surgery to relieve its compression.

Forecast

With timely treatment, it is possible to restore the functions of the radial nerve in 1-2 months. The timing and extent of nerve recovery largely depend on the depth and extent of its damage. In some cases, the disease becomes chronic and periodically worsens.

Radial nerve neuropathy is a common pathology, well known to neurologists, the main cause of which is compression of the nerve under the influence of various factors with the appearance of characteristic symptoms.

A pathological condition of a nerve or several nerves that occurs as a result of compression, trauma, infections or other causes and leads to functional disorders in the area of innervation of the nerve, ischemic processes and trophic disorders in the surrounding tissues is called radial nerve neuropathy.

The basis of the neuropathic process is the destruction of nerve structures due to malnutrition and exposure to toxic substances coming from the zone of inflammation of surrounding tissues, pain and swelling occurs in the innervation zone and sensory, motor, autonomic and trophic disorders appear.

Why does it occur?

While sleeping in an uncomfortable position, the radial nerve is compressed by surrounding tissues - neuropathy develops.

Damage to the radial nerve is more common among other nerves of the upper limb: median or. The reason for this may be the following factors:

Compression-pinching (squeezing) of a nerve: a) during sleep, when a person is in an uncomfortable position on a hard surface for a long time, the hand is pressed by the head or torso, for example, during the deep sleep phase due to alcohol intoxication or severe fatigue; b) “crutch” paralysis—compression of a nerve by a crutch; c) there may be cases of compression by a pacemaker; d) tumor of the axillary fossa.
Nerve injury resulting from a fracture of the humerus, dislocation of the shoulder or forearm;
Iatrogenic factors are associated with medical error: a) compression by a tourniquet when performing manipulations to stop bleeding, when it is on the arm for a long time; b) violation of the technique of intramuscular or subcutaneous injections into the shoulder area, when there are peculiarities of the anatomical location of the nerve and a high risk of damage;
Infectious nerve lesions. Bacterial: for typhus, pneumonia, tuberculosis; Viral: influenza, pneumonia, ;
Intoxication (in rare cases) with lead, arsenic.

A little anatomy

Before moving on to the symptoms of radial nerve pathology, let us recall its anatomical features. So, the radial nerve is peripheral, that is, it is located outside the brain or spinal cord and is part of the brachial plexus. It is formed by fibers of the root of the 5th and part of the 8th cervical and partly by the root of the 1st thoracic spinal nerves, descends down into the axilla (the first place of possible compression of the radial nerve as a result of external influence) from the brachial plexus in the form of its posterior secondary bundle. Next, the nerve goes down along the humerus, passes in the so-called groove of the radial nerve (bone spiral groove), presses tightly against it, bending around it in the form of a spiral, behind it in its middle third (the second place of probable compression of the nerve).

In the area of the capsule of the elbow joint, the radial nerve gives off two branches, superficial and deep. The first runs along the outer surface of the forearm and passes to the dorsal (posterior) surface of the lower end of the forearm, is divided into small branches that innervate the radial half of the dorsum of the hand from the nail phalanx of the 1st finger, the middle phalanx of the 2nd, and the radial side of the 3rd finger .

The radial nerve contains motor and sensory fibers, which is why it is called mixed. The motor portion of the fibers innervates the extensor muscles of the shoulder (triceps muscle), wrist, fingers, the supinator (performs the function of abduction) of the forearm, and the muscle that abducts the thumb. The sensitive part of the nerve fibers of the radial nerve branches in the skin of the shoulder, forearm on the dorsal (back) side, the back of the hand and the first three fingers of the hand.

Clinic of the lesion

The presence of certain clinical manifestations will depend on the level of nerve damage:

motor;
sensitive;
trophic and vegetative.

If this is the area of the armpit and shoulder in the middle third, then the following disorders occur: a) motor: decreased strength (paresis) of the muscles innervated by this nerve, in this case, when the patient tries to raise his arms and stretch them in front of him, the hand with a pathological the nerve will hang down (“dangling hand”). It is impossible to move the first finger away from the second, to straighten the forearm and hand due to damage to the extensor muscles. The third finger is superimposed on the adjacent one. Supination (outward rotation) of the forearm when extending the arm is difficult. There is no ulnar (extensor) reflex (when struck with a neurological hammer from the outside of the elbow joint, the forearm is extended) and the carporadial reflex is reduced (tapping with a hammer in the wrist area at the styloid process of the radius leads to flexion of the forearm at the elbow joint and phalanges of the fingers. b) Sensitive: burning pain and a feeling of tingling, numbness in the fingers and forearm, hypoesthesia (decreased sensitivity) of the outer side of the forearm, skin in the area of the middle phalanges of the thumb and index fingers in the radial half of the hand.
If the nerve in the middle third of the shoulder is damaged, the extension of the forearm is not impaired, the ulnar extensor reflex remains intact, the sensitivity in the shoulder does not change, but all the other symptoms described above are present.
In the case of compression of the nerve at the level of the lower third of the shoulder and the upper third of the forearm (one of the most common options), the extensor function of the muscles of the hand and fingers may be impaired, and hypoesthesia of the fingers and the back of the hand may appear.

Autonomic disorders in the innervation zone occur in the form of cold temperatures, “blue discoloration,” paleness of the fingers, and impaired sweating of the skin.

Trophic - muscle nutrition is disrupted due to nerve damage - the muscle loses weight, becomes flabby, the skin on the sore arm is dry, thin, trophic ulcers may appear.

Arch support syndrome

In the most common cases, the radial nerve can be affected in the canal of the supinator fascia of the forearm by compression of the supinator muscle bundles (supinator syndrome). It manifests itself as pain, usually in the elbow, lateral surface of the forearm and dorsum of the hand, which intensifies more often at night. During the day, pain may occur when doing manual work. Pain syndrome is also provoked by rotational movements of the forearm (pronation, supination). Complaints of weakness in the hand may often appear, primarily weakness in extension of the little finger, which appears during work, this leads to disruption of the coordinated movement of the fingers and hand, but wrist extension remains - a cardinal symptom that distinguishes nerve compression in the supinator canal from damage to it on the shoulder .

Radial tunnel syndrome

Neuropathy of the branches of the radial nerve can be at the level of the elbow and wrist joint.

Damage to the branches of the nerve at the elbow level is a consequence of severe compression of its bone or connective tissue by the fibers of the triceps brachii muscle, inflammation of the capsule of the elbow joint, at the wrist level - the result of injuries to the radius or ulna, tumors of bone tissue, pressure from a bracelet, watch strap or handcuffs, which can cause numbness and acute burning pain in the upper forearm, back of the hand and fingers (or only the 1st finger), intensifying when straightening the fingers. Hypesthesia (decreased sensitivity) of the radial side of the 1st finger and muscle paresis may occur, but they are caused less frequently than with cubital tunnel syndrome.

Diagnostics

Electroneuromyography will help determine the location of nerve damage.

It is advisable to carry out some diagnostic tests to make a correct diagnosis:

the patient presses his palms tightly against each other with straightened fingers so that the wrists touch and when the hands are extended, the fingers of the affected hand do not move away, but bend and make sliding movements along the healthy palm, and it will also be difficult to spread the fingers;
the back of the hand and the patient’s fingers cannot simultaneously touch a flat surface;
if you lower your hands, then on the affected hand it is impossible to abduct the thumb or turn the hand outward;
with the hand on the palmar surface, it is difficult to place the third finger on the adjacent one.

More complete information about the location of the nerve lesion is obtained using ENMG.

In the program “Live Healthy!” with Elena Malysheva about damage to the radial nerve (see from 34:00 min.):

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Signs: complete or partial disruption of conductivity, symptoms of loss of movement, sensitivity and autonomic functions in the area of all branches of the nerve below the level of its damage.

Median nerve. With isolated damage, pronation suffers, palmar flexion of the hand is weakened, flexion of the 1st, 2nd, 3rd fingers and extension of the middle phalanges of the 2nd and 3rd fingers are impaired. Atrophy of the muscles of the radial half develops: the superficial head of the deep flexor of the first finger, the muscles of the opponens and short abductor of the first finger and the first and second lumbrical muscles of the hand. Opposition, abduction and rotation of the first finger are impaired. The hand becomes like a monkey's paw. The sensitivity of the skin of the palmar surface of the I, II, III fingers and the radial side of the IV finger, the corresponding part of the palm, as well as on the back of the distal phalanges of these fingers is impaired (Fig. 1).

Rice. 1. Symptoms of damage to the median nerve: a - “monkey’s paw”; b - zones of sensitivity impairment; c - when trying to clench your fingers into a fist, fingers I and II do not bend

Vasomotor-secretory-trophic disorders are characteristic. The skin of the 1st, 2nd, and 3rd fingers becomes bluish or pale, the nails become dull, brittle and streaked. The soft tissues are atrophic, the fingers are thinned, hyperkeratosis, hyperhidrosis, and ulcerations are pronounced.

When trying to hold a sheet of paper between fingers II and I, the patient is forced to straighten finger I in order to grasp using the adductor muscle innervated by the ulnar nerve. The patient loses the sense of feeling objects; due to the lack of opposition of the first finger, all types of grips are impaired. The hand is used only for auxiliary actions. With simultaneous damage to the tendons, the hand becomes generally unsuitable for work.

Ulnar nerve. Complete damage to the ulnar nerve causes weakening of the palmar flexion of the hand, lack of flexion of the fourth, fifth and part of the third finger, the inability to bring and spread the fingers, especially the fourth and fifth, and the inability to adduct the first finger. Atrophy of the hypothenar muscles, adductor muscles of the first finger, two lumbricals and all interosseous muscles develops. There is a flexion position of the middle and nail phalanges of the IV, V fingers, hyperextension of the main phalanges of the IV, V fingers, there is no adduction and opposition

V finger. As a result, the hand takes on the appearance of a clawed bird's paw. Usually, superficial sensitivity is impaired on the skin of the fifth finger, the ulnar half of the fourth finger and the corresponding ulnar part of the hand (Fig. 2).

Rice. 2. Symptoms of damage to the ulnar nerve: a - “clawed” hand; b - zones of sensitivity impairment; c - when trying to clench your fingers into a fist, IV and V fingers do not bend

The joint-muscular feeling is upset in the fifth finger. Possible cyanosis, sweating disorders and a decrease in skin temperature in an area approximately coinciding with the area of sensitivity disorders. The function of the hand in patients with damage to the ulnar nerve differs significantly from the function of the uninjured hand, which is especially evident when both hands are used simultaneously. The affected hand is not involved in activities that require active finger work (speed, strength, dexterity). Performing manipulations with such a hand is more difficult compared to an uninjured hand. Loss of sensitivity along the medial edge of the palm and on the fifth finger forces patients to limit the activity of the defective hand due to more active use of the intact hand. This is especially noticeable when writing, when part of the palm and the fifth finger, deprived of sensitivity, are adjacent to the table. Due to loss of function of small muscles, rapid hand fatigue appears. Fear of getting a burn or injury forces patients to unnecessarily spare the damaged hand.

Damage to the median and ulnar nerves. With combined damage to the median and ulnar nerves, hand deformation develops, which is characteristic of damage to each of these nerves, but leads to more severe impairment of hand function. The ability to make flexion movements of the hand and fingers is completely lost. Prolonged vicious position of the hand causes secondary changes (persistent deformation of the longitudinal and transverse arches of the arch of the hand with its flattening, compaction and wrinkling of the capsule of the metacarpophalangeal joints with subsequent flexion-extension contracture of the fingers).

The function of the hand is insufficient even for basic labor processes, since all types of grip are impaired. In the zone of innervation of damaged nerves there is no sensitivity, trophic disorders develop (skin cyanosis, hyperkeratosis, decreased sweating and skin temperature). The more distally the nerve is damaged, the more severely vasomotor and trophic disorders manifest themselves. The longer the period of deinnervation, the more pronounced the secondary disorders.

In everyday life, such patients use the affected hand only for minor actions, mainly to support large objects grasped by the healthy hand.

Radial nerve consists of sensory and motor fibers. Motor fibers innervate the extensors of the forearm, hand and fingers. Sensitive fibers innervate the skin of the dorsum of the forearm, the radial side of the dorsum of the hand and partially the first, second, and less often the third finger. More often, the radial nerve is damaged at the level of the middle third of the shoulder, and supination is disrupted and the hand hangs down. The fingers in the main phalanges are half-bent and hang down in a step-like manner (Fig. 3). Abduction of the first finger is impossible.

Rice. 3. Symptoms of damage to the radial nerve: a - “dangling” hand; b - zones of sensitivity impairment; c - when trying to open the closed palms, the fingers of the injured hand bend passively

There is no active extension in the wrist and metacarpophalangeal joints. It is impossible to clench the hand into a fist. Only after fixing the forearm in a supinated position can the patient clench his fingers and grasp the object. Tactile sensitivity suffers, pain persists. Autonomic disorders are expressed in the form of cyanosis, edema and swelling on the back of the hand.

Hypertrichosis is observed on the dorsum of the forearm and hand, and significant osteoporosis of the wrist bones. The ability to extend the fingers is determined when the metacarpophalangeal joints are in a bent position (to turn off the function of the interosseous muscles that are capable of extending the distal joints of the outstretched fingers). When attempting dorsal extension of the hands, connected to each other with palms with straightened fingers, on the injured side, the hand is bent, following the extension of the healthy hand, the fingers are not abducted and, bent, slide along the palm of the healthy, abducted hand (Triumfov test).

With improper treatment, persistent contracture of the hand develops in the position of flexion at the wrist joint and adduction of the first finger.

A combination of damage to tendons and nerve trunks. Damage to tendons in the forearm, hand and fingers, especially with transverse incised wounds, is often combined with nerve damage. Damage to the peripheral nerves of the hand is manifested by impaired motor and sensory functions. There are tactile, tactile, thermal, pain and deep sensitivity.

The simplest way to study tactile sensitivity is to lightly touch the skin with a piece of cotton wool. Pain sensitivity is determined by needle pricks, by squeezing or pinching the distal phalanx of the finger in the autonomous zone of the nerve (II finger - if there is suspected damage to the median nerve, V finger - if there is suspected damage to the ulnar nerve). These studies are subjective, they are unacceptable in children, in seriously injured people, in the mentally disabled, in those suffering from pain.

Gives a qualitative and quantitative assessment of sensitivity disorders Weber discrimination test. Applying two injections at a distance of 2-5 mm (with a compass or two ends of a paper clip) on the fingertip of an uninjured hand is felt as two injections, on the damaged hand as one. By increasing the distance, the discrimination limit can be quantified.

The state of stereognosis (complex sensitivity) is determined using Moberg cognitive test. Small items used in everyday life are laid out on the table - buttons, keys, coins, screws, paper clips, etc. The patient is asked to quickly collect these items into a box separately with the healthy and injured hand. After several attempts, the patient is asked to collect the same objects blindly, recognizing each of them by touch. If the patient recognizes all objects quickly, in 5 seconds or less, then the stereognosis of his hand is sufficient to perform any work - fine or rough.

Changes in the sensory sphere with combined injuries of tendons and nerves are studied in terms of temperature and tactile sensitivity.

To determine disorders of autonomic functions, Moberg proposed ninhydrin test: fingertips are pressed against paper soaked in ninhydrin, and after taking prints, the paper is heated. The absence of an imprint indicates a violation of sweating as a result of disorders of autonomic function. Clinical signs also indicate sensitivity disorders: wasting of the hand muscles, hyperkeratosis, hypo- or hyperhidrosis, hypertrichosis, cyanosis of the fingers.

Traumatology and orthopedics. N. V. Kornilov