Radial Nerve Compression
The radial nerve is the third major peripheral nerve within the arm. It is commonly compressed within the proximal forearm, i.e., at the level of the elbow in patients that have chronic tennis elbow or lateral epicondylitis. Symptoms classically present as a deep seeded pain within the forearm which extends on to the dorsum or top side of the hand with associated numbness. In addition, it can present with weakness of supination, i.e., turning the palm up and/or weakness in extension of the wrist and/or fingers. Treatment initially consists of conservative management including splinting and the use of anti-inflammatories and/or iontophoresis which is an ultrasound type of procedure utilizing medication, i.e., a cortisone preparation pulsed into the muscles and area around the nerve to decrease inflammation. If this is not successful, then decompression of the nerve surgically is performed.
This involves removing and excising tight fascial bands which may be compressing the radial nerve within the arm and forearm. A less common form of compression of the radial nerve includes that of compression of the sensory nerve at the level of the brachioradialis muscle tendon unit further distally within the forearm. This situation presents with only numbness within the radial nerve distribution within the hand, i.e., on the dorsum or top side of the thumb, and/or index finger. The brachioradialis tendon actually causes compression on the nerve within the distal aspect of the forearm. Treatment initially includes splinting and/or injection of cortisone to decrease the inflammation around the tendon unit. If this is not successful, then surgical intervention is warranted by dividing the tendon that compresses the nerve. Again, in either case, a postoperative course consists of keeping the arm clean and dry for approximately 2 weeks, immediate immobilization of the arm and fingers and a brief period of therapy after the removal of sutures.