The radial nerve runs from the neck, wraps around the upper arm bone and extends all the way into the forearm and hand, quietly doing the work of lifting your wrist, extending your fingers and relaying sensation to the back of your hand. When it gets damaged, that work stops, and you feel it fast.

A radial nerve injury can develop gradually or come on suddenly after a fracture, a fall or even something as ordinary as sleeping with prolonged pressure on the arm. Whatever the cause, the disruption tends to affect the simplest things first: picking up a coffee cup, opening the hand, pulling on a jacket. Getting an accurate diagnosis early makes a real difference in how well and how quickly the nerve recovers.

Symptoms of Radial Nerve Injury

Wrist drop is the most recognizable sign of a radial nerve injury. The wrist hangs down and resists being raised because the muscles responsible for that movement are no longer getting a clear signal from the nerve.

Not every case is that obvious. Some patients come in describing vague aching along the outer elbow or forearm, or tingling across the back of the hand that they initially dismissed. Other ways a radial nerve injury can present include:

• Trouble releasing objects after gripping them
• Difficulty straightening the fingers or thumb
• A general sense that the hand is not cooperating

Causes and Risk Factors

Sustained pressure is a common factor. Sleeping with the arm pinned under the body for hours, leaning on the upper arm against a hard edge or holding an unusual position for too long can all compress the nerve enough to interfere with its function. Usually this resolves with rest once the pressure is gone.

Fractures are a more serious cause. The radial nerve travels close to the humerus, so when the upper arm bone breaks, the nerve can be stretched, bruised or directly caught in the injury. Furthermore, the nerve can be injured during surgical exposure or fracture open reduction and internal fixation, requiring interoperative management and repair or delayed repair for complex cases.

Radial nerve injury is a recognized complication of humeral shaft fractures. Cuts, crush injuries and high-force trauma can also damage the nerve outright. In some patients, the problem is entrapment near the elbow, where the nerve passes through a narrow channel of muscle, bone and tendon, a condition known as radial tunnel syndrome.

Diagnosis

Your physician will want to know the full story: when the symptoms started, whether there was any trauma, which movements feel off and whether the problem has been getting better or worse. From there, the physical exam focuses on wrist and finger extension, thumb movement, grip and sensation along the back of the hand.

Diagnostics include imaging, X-rays and electrodiagnostic. X-rays check for fractures or structural problems near the nerve. MRI or ultrasound can show how the nerve and surrounding tissue look, which becomes particularly important if surgery is on the table. Electrodiagnostic studies, including nerve conduction testing and EMG, measure how well electrical signals are moving through the nerve and how the muscles are responding.

Treatment

Non-Surgical Treatment

When the nerve has not been cut, conservative care works well for many patients. Rest, avoiding the positions that aggravate the nerve and anti-inflammatory medication when appropriate are often the starting point. Splinting or bracing supports the wrist and fingers so you can continue functioning during daily activities while the nerve heals.

Hand therapy is a key part of the process, maintaining joint motion, working on grip and release and using nerve gliding exercises to keep the nerve moving freely through surrounding tissue.

Surgical Treatment

Surgery becomes the right conversation when the nerve was cut, is trapped under scar tissue or simply has not recovered the way it should. Options range from decompression and neurolysis to direct nerve repair, nerve grafting and, in more complex situations, nerve or tendon transfer. Surgery may be warranted when an injury shows no adequate signs of healing on its own.

Recovery

Nerve tissue heals slowly. For compressed injuries in which the nerve remains intact, most patients see meaningful progress within a few months. Injuries involving a torn or severed nerve take considerably longer, and surgery is usually necessary before recovery can move forward at all.

Research on radial nerve injury tied to fractures points to an average recovery of around 24 weeks, though that number shifts depending on severity and how early treatment began. Physical therapy throughout the recovery period helps preserve joint mobility and restore practical hand function as the nerve gradually returns to normal.

Talk to a Specialist in New Jersey

Weakness, numbness and loss of hand function are worth taking seriously. The hand and upper extremity surgeons at University Orthopaedic Associates bring subspecialty certification in surgery of the hand and upper extremity, working alongside certified hand therapists who are integrated directly into patient care.

UOA has offices in Somerset, Princeton, Wall, Morganville, Woodbridge and Monroe. For radial nerve injury treatment in New Jersey from a team that handles everything from initial imaging to surgical care and rehabilitation, request an appointment today.