The radial nerve is a structure of mixed fibers. It starts from the cervical plexus and goes towards the hand.
Responsible for the innervation of the arm, flexion movements of the hand and skin sensitivity.
If it is damaged and left untreated, a person is deprived of the ability to act with this limb, to make subtle movements with the hand and fingers. This leads to disability.
The article discusses what radial neuritis is, how it manifests itself, and how it is treated.
What is it and the ICD-10 code
Radial neuritis is an inflammatory pathology that affects the nerve fiber itself and its sheath. Its ICD-10 code is (G56.3) .
Nerve damage is often caused by pinching. This is accompanied by pain, loss of motor function of the arm in the forearm, shoulder and hand with decreased skin sensitivity.
The arm stops bending at the wrist and elbow joints . Its frequent development is facilitated by the anatomical features of the location of this nervous structure.
These include:
- spiral course of the nerve trunk;
- close to the surface of the skin.
Thanks to this, it is easily and quickly affected by any adverse effects.
Discussion
The recurrent radial arteries are branches of the radial artery passing between the trunk of the spinal nerve and having an anastomosis with the distal portion of the deep brachial artery [15]. The literature [16–20] provides a description of various neurovascular compression syndromes of the arms with different patient management tactics: compression of the anterior interosseous nerve by a branch of the anterior interosseous artery, compression of the ulnar nerve in Guyon’s canal due to thrombosis or aneurysm of the ulnar artery, compression of the ulnar nerve by the recurrent radial arteries, compression of the brachial plexus of the posterior scapular artery.
The ultrasound picture of compression neuropathy of the recurrent radial arteries is described only in one observation (2013), in which C. Rolla Bigliani et al. [19] presented a case of changes in the shape of the nerve with subsequent confirmation of the diagnosis intraoperatively.
Causes of inflammation
There are several causes of damage to the radial nerve for the right and left arms.
These include:
- complications after an infectious disease, bacterial or viral;
- traumatic effect on the nerve fiber - this can be prolonged compression and disruption of blood supply due to an uncomfortable sleeping position, using a crutch or a tourniquet to stop bleeding;
- direct injury to the nerve due to injury or bruise, injection into the outer surface of the shoulder;
- compression of the nerve by a keloid scar formed after injury in the space between the muscles;
- toxic effects on nerve fibers from household and industrial toxic substances, carbon oxides, salts of heavy metals (lead, mercury).
These reasons lead to disruption of the conduction of impulses along the nerve fiber of the radial nerve.
What causes this type of neuropathy?
Most often, radial nerve neuropathy develops as a result of prolonged exposure to compression (during sleep, when forced to be in an uncomfortable position). The so-called “sleep paralysis” often occurs in those whose sleep is so sound that they do not change their position for a long time. This happens due to various circumstances: for completely healthy people it is regular lack of sleep, heavy physical activity. Well, for those who are prone to taking alcohol or drugs, severe intoxication of the body can disable motor functions for a long time with predictable negative consequences. Sometimes neuralgia is observed after applying a tourniquet, in the presence of a lipoma or fibroma in close proximity to the nerve. The names of the paralysis “prisoner” and “crutch” correspond to the localization of the problem of compression neuralgia: in the first case, the nerve in the area of the wrist cuffed with handcuffs is affected, in the second, the axillary region where the crutches rest is affected.
Traumatic neuropathy of the radial nerve occurs with fractures, bruises and dislocations. Also factors in the development of the disease are changes caused by joint diseases. At risk are patients diagnosed with arthritis, bursitis, etc. Rarely, but still contribute to the development of ulnar neuralgia, diseases caused by infections of various pathogenesis - typhoid, influenza, etc., poisoning with low-quality alcohol or lead.
Symptoms and manifestations of damage
When the radial nerve is damaged, the patient loses fine motor skills of the hands, and movements in the hand are impaired. He cannot perform both complex and elementary actions with it. There is a loss of sensitivity or a decrease in it in characteristic areas.
Pain along the nerve trunk is extremely rare in patients. This only happens with infectious and traumatic lesions. The right upper limb is more affected.
Manifestations of neuritis of the radial nerve of the right and left hand depend on the location of the inflammation.
Depending on this, the following symptoms occur at different levels:
- With high nerve damage in the armpit area, paralysis of the extensor muscles of the fingers, hand and forearm is observed.
- For lesions in the middle third of the nerve trunk (at the level of the middle third of the shoulder), extension of the forearm and hand is typically affected. Movement in the shoulder is preserved.
- Damage to the nerve in the lower third of the shoulder is manifested by impaired flexion of the fingers and hand. All other movements in the arm (flexion of the weep and forearm) are preserved.
- If the nerve is damaged at the level of the lower part of the forearm, the ability to extend the fingers disappears or decreases. All other functions are retained. Patients develop a “dangling hand” typical of this nerve lesion. The thumb is pressed against the index finger. The patient is unable to shake hands and the fingers are fully extended.
Find out about the symptoms of other types of neuritis of the extremities:
- upper - brachial, ulnar, median nerves;
- sciatic nerve;
- lower - femoral, tibial and peroneal nerves.
Possible patient complaints
Patients present a variety of complaints of weakness in the arm, fingers and hand, and decreased range of motion. Their pain radiates or even shoots into the third, second and first fingers of the hand.
They complain of numbness in the affected hand, goose bumps in the fingers of the hand, except for the fourth and fifth, the outer side of the shoulder and the inner side of the forearm.
There is a violation of deep and superficial sensitivity in the area of the fingers (I-III) and forearm on the inside. The brush swells and acquires a bluish-purple color.
The patient notes a violation of the flexion of the wrist joint, the fingers do not straighten . Occasionally, numbness along the nerve trunk is possible.
A comment
The presented work touches on the current topic of compression neuropathies of the upper limb and the importance of sonography in diagnosing the nature and determining the level of compression. The similarity of the clinical picture of compression neuropathies of the radial nerve makes diagnosing the level of compression paramount when planning and choosing surgical treatment tactics. The authors’ use of this examination method makes it possible to identify rare variants of pathology. The small number of Russian-language works devoted to rare neuropathies makes this publication relevant, including in the journal “Problems of Neurosurgery.” The fact that the authors pay attention to such clinical situations and describe rare cases in the Russian-language literature is also a practically significant contribution to understanding the problem. When preparing the publication, the authors conducted a significant literature search. The cited literary sources are relevant and reflect both the development and the current state of the problem. The design of the work meets the requirements; when writing, it is fully consistent. The conclusion and conclusions are justified and reflect the content of the work. The practical significance of the work is obvious, as it draws the attention of specialists to the need to use ultrasound in the diagnostic algorithm for pathology of the peripheral nervous system.
A.V. Shtok (Moscow)
Diagnostic methods
A neurologist treats radial nerve neuritis . First, he asks the patient about complaints and medical history.
Finds out under what circumstances and when the signs appeared. Then the doctor proceeds directly to examining the patient. Based on this, he makes a preliminary diagnosis.
A neurological examination reveals:
- During examination of the patient's hand, a characteristic drooping hand is revealed when the arm is extended forward.
- Difficulties in bending joints are revealed. The patient does not straighten his hand, forearm, and his arm does not straighten at the elbow joint.
- When examined with a neurological hammer, the doctor detects a decrease in the carporadial and extensor reflexes.
- There is a violation of skin sensitivity in the area of the 1st, 2nd, and 3rd fingers.
- A series of tests are performed to determine the level of radial nerve damage. He cannot move his thumb to the side. The patient is unable to simultaneously touch the back of the hands with all fingers. He cannot place his palms on the table and cross his middle and second fingers. A patient with damage to the nerve trunk is unable to spread his fingers to the sides.
Tests and neurological examination data may suggest damage to the radial nerve. It can be confirmed by performing a series of instrumental studies.
Electroneuromyography plays a leading role in making a diagnosis. It allows you to determine a violation of the conduction of a nerve impulse along a nerve fiber and a defect in the innervation of certain muscle groups. There is a decrease in the amplitude of the muscle response to electric current stimulation.
They also conduct electroneurography , which reveals a slowdown in conduction along the nerve trunk.
In addition to these studies, additional testing is carried out. They are carried out to identify the cause of damage to the radial nerve.
These include:
- consultations with a traumatologist, orthopedist and endocrinologist;
- blood biochemistry;
- determine blood sugar levels;
- general blood analysis;
- radiography of the bones of the shoulder, forearm, hand;
- CT scan of the elbow and wrist joints.
What diseases should be distinguished from?
Differential diagnosis for neuritis of the radial nerve is carried out with neuropathy . It is characterized by all the same symptoms, but there is no pain syndrome.
Neuritis should also be distinguished from post-traumatic compression of the radial nerve . To do this, a hydrocortisone-novocaine blockade is carried out in the area of its membranes.
When the nerve fiber is compressed, relief of symptoms is observed, which is absent with neuritis.
Features of treatment
Treatment of the radial nerve is carried out only by a neurologist or a rehabilitation specialist. Self-medication is unacceptable. The limb must be immobilized during treatment.
Therapy has two goals. The first is treatment of the underlying disease or injury that led to the nerve damage. The second is the removal of symptoms: pain, swelling, sensory disturbances and decreased muscle strength. Its tactics are determined by the cause of the disease and the level of damage.
The following drugs are used:
- Non-steroidal anti-inflammatory drugs (Ibuprofen, Nimesulide) reduce hand swelling and nerve inflammation.
Angioprotectors are used to improve regional blood circulation and blood supply to the nerve trunk. Used: Actovegin, Pentoxifylline, Trental.- Anticholinesterase drugs (Prozerin) enhance the conduction of impulses along the nerve.
- B vitamins improve metabolism in nerve fiber.
For treatment, drugs high in vitamins B1, B6 and B12 are used. Vitamin complexes are used: Neuromultivit, Neurodiclovit and others. - To treat severe pain and swelling, I use glucocorticoids; they have anti-edema and anti-inflammatory properties.
- Antioxidants (Vitamin E, Vitamin C) reduce the severity of damage in the nerve fiber.
In the recovery period for neuritis , physiotherapy, electrical myostimulation, acupuncture, massage, and exercise therapy are prescribed .
Physical therapy plays an important role in the treatment of neuritis of this localization. A set of exercises is developed by a rehabilitation specialist for each patient.
The following exercises are used:
- The patient is seated at the table. He bends at the elbow joint and rests against the surface of the table. In this position, he raises his index finger up and lowers his thumb down. The exercise is performed ten times.
- In the same position, raise your thumb up and your index finger down. The exercise is performed ten times.
- Extend the fingers of the healthy hand ten times. Then grab the fingers of the affected hand into a fist with your healthy hand and squeeze ten times.
In rare cases, if there is no effect from conservative treatment, surgery is performed . With them, the nerve is released from compression.
Prognosis and prevention
Radial neuritis responds well to treatment in young people . In the elderly, neuritis, in the presence of concomitant diseases, is difficult to treat. Complications develop quickly.
To prevent diseases, it is necessary to promptly treat the pathologies that cause them. Radiation neuritis is caused by a complex of causes.
With minimal manifestations of illness, numbness, or weakness in a limb, you should consult a doctor and follow all his prescriptions and recommendations .
Otherwise, paralysis and paresis occur, and disability develops. This significantly reduces the patient’s ability to work and quality of life.
