Middle radial palsy is a paresis of the radial nerve. In this case, the paralysis occurs in the area of the distal upper arm and usually results from injury or other external factors. Middle radial nerve palsy is usually localized within what is known as the radial sulcus.
What is middle radial palsy?
Middle radial palsy causes affected individuals to experience limitations in arm, wrist, and finger mobility. In the majority of cases, middle radial palsy manifests on only one side of the body. This is because a simultaneous occurrence of the underlying factors on both arms is rather rare. For example, patients have difficulty extending their wrist due to middle radial palsy. In numerous cases, middle radialis palsy disappears on its own. As a rule, the treatment of this condition depends largely on the cause. In many cases, just resting the entire musculature can lead to a positive course of the disease. However, in some cases surgical interventions are necessary to solve the symptoms. This does not affect the patient’s life expectancy. If the nerves have been irreversibly damaged, treatment is no longer possible in many cases.
Causes
The causes leading to the development of middle radial palsy vary from case to case. Basically, various factors and influences are capable of triggering middle radial palsy. In numerous cases, this involves damage to the radial nerve, which occurs in the distal section of the upper arm. In numerous patients, middle radial palsy develops as a result of the action of pressure on the corresponding nerve. The pressure becomes a problem especially when it persists for a long period of time. This is the case, for example, when the arm has been in the same position for an unusually long time, such as on a hard surface or the back of a chair. Sometimes, therefore, the condition is also called park bench paralysis. Plaster casts that are applied too tightly also damage or irritate the radial nerve under certain circumstances. In addition, in some cases, middle radial nerve palsy develops in association with fractures of the bone of the upper arm (medical term humerus).
Symptoms, complaints, and signs
The characteristic symptoms and signs of disease of middle radial palsy are numerous. For example, affected patients have impaired supination and abduction of the radius and ulna. Sometimes, as a result of the paralysis, the affected individuals are unable to extend their wrist as usual. These disorders result primarily from irritation of certain muscles, for example, the supinator muscle. The inability to extend usually affects not only the joint of the hand, but also the joints of the fingers. For this reason, physicians also call the symptomatology drop hand or finger. Muscles such as the extensor indicis muscle fail in the course of this complaint. Flexion of the lower arm is also only insufficiently possible as a result of middle radialis paralysis. In addition, affected individuals show a reduction in the radius periosteal reflex. Paralysis of the middle radialis also leads to disturbances in sensibility, which are primarily concentrated in the lower arm region. In contrast, similar complaints do not occur in the upper arm. The triceps tendon reflex is largely maintained during middle radial palsy.
Diagnosis and course of the disease
The diagnosis of middle radial palsy should be made by a physician. Therefore, medical advice should be sought immediately if the presence of such paresis is suspected. This is because therapy may be required, and starting treatment early has a positive effect on the prognosis and quality of life of affected individuals. The physician usually begins the examination with an anamnesis. The aim is to find out about the individual complaints and to obtain information about potential causes for the complaints. In many cases, this information can already be used to draw conclusions about the disease, enabling the physician to make a tentative diagnosis.Neurological examinations are essential for a reliable diagnosis of middle radial palsy. The physician checks the extent to which the patient is able to extend and bend his lower arm. In addition, tests are performed to determine whether extension of the hand and finger joints is possible. Other significant indications come from whether the triceps tendon reflex and the radius periosteal reflex are still functioning. In this way, it is also possible to find out where the damage to the radial nerve is located. This makes it possible to differentiate it from upper radialis palsy, which should always be done as part of the differential diagnosis. Electroneurography is suitable for confirming the diagnosis of middle radial palsy.
Complications
Middle radial palsy causes severe limitations in the patient’s daily life. In most cases, the affected person can no longer fully extend his wrist in the process. This results in disabilities in everyday life and in various tasks, which significantly reduce the quality of life. Especially in children, radialis paralysis can lead to developmental disorders. It is not uncommon that the fingers can no longer be stretched or moved. Furthermore, in some cases the paralysis also affects the entire arm, so that the affected person may be dependent on the help of other people in his or her daily life. Radialis paralysis also significantly limits and reduces the patient’s protective mechanism, making it easier for various injuries to occur.
When should you see a doctor?
Persistent or sudden disturbances of movement indicate a health impairment that should be clarified by a doctor. If there is paralysis, irregularity of motor function, or loss of usual muscle strength, a doctor is needed. Middle radialis palsy is characterized by disorders of the wrist. Therefore, a visit to the doctor is recommended as soon as, for example, the extension movements of the hand can no longer be performed. If the affected person is unable to move the hand, wrist or fingers as usual, a visit to the doctor should be made. As soon as everyday hand movements, for example brushing teeth, washing or getting dressed, can no longer be performed without interference, it is advisable to seek medical attention. If the flexion of the lower arm can no longer be fully performed, a clarification of the symptoms is needed. If the health condition deteriorates, everyday activities can no longer be performed or sensory disturbances occur, a doctor should be consulted. If the affected person is unable to perform grasping movements, to do paperwork, or if the complaints lead to increased insecurity and minor accidents at home, medical help is necessary. If there are also emotional irregularities in addition to the physical ones, there is a need for action. In the case of mood swings, behavioral abnormalities or a deep sense of despair, the support and help of a doctor can provide relief.
Treatment and therapy
Measures of treatment for middle radial nerve palsy depend primarily on the precipitating factors. Paresis of the nerve due to pressure damage does not require treatment in numerous cases. By resting the affected arm, the symptoms usually improve on their own and disappear after a few days. In this case, the prognosis for middle radial nerve palsy is basically good. If the shaft of the upper arm is broken and the radial nerve is damaged as a result, surgical intervention is usually necessary. This also applies to so-called comminuted fractures, which are reconstructed as much as possible during surgery.
Outlook and prognosis
In general, middle radial palsy leads to a good prognosis. This is especially true when it results from a pressure lesion. Sufferers usually do not require medical therapy. Rest is sufficient. The body has sufficient strength to produce healing after a few days. A restriction of the quality of life is not to be expected. The life time is not shortened by a middle radialis paralysis. Treatment for a comminuted fracture is considerably more complex. However, even for this case, scientific medicine has developed sufficient therapeutic approaches to achieve complete relief of the symptoms in most cases. The prospects can also still be described as good.Early initiation of treatment is essential. Basically, recovery also depends on the physical condition at the time of an illness. People of advanced age and those with pre-existing conditions take significantly longer to heal. They also suffer more from movement restrictions and pain after the initial treatment. It may be that certain sports may no longer be performed or only with light exertion. Restrictions may apply to lifting heavy objects.
Prevention
Preventive measures to avoid middle radial palsy address the precipitating factors of the paresis. If possible, pressure damage to the corresponding nerve should be avoided and the arm should be spared.
Follow-up
Whether follow-up treatment is necessary for a moderate radial nerve palsy depends on the specific case. However, in most cases, there is no need to perform any examinations or take any further action. The signs of the disease disappear by themselves without treatment. Therefore, as a rule, there is no need for a follow-up examination by a physician. In the case of long-lasting symptoms of middle radial palsy or incomplete healing, it is usually necessary to continue treatment or take certain rehabilitation measures. The specific follow-up treatments that should be taken depend on the cause of the disease and the therapeutic measures chosen. In any case, regular check-ups with a specialist are necessary. Basically, the most important measure for aftercare is extensive sparing of the affected arm. If the middle radialis paralysis is caused by a fracture of the upper arm, surgical treatment usually follows. In the course of aftercare, the healing of the surgical scar is particularly important at first. For this reason, some medical examinations are necessary, which can usually be performed on an outpatient basis. Furthermore, physiotherapeutic treatment is advisable in most cases. Through this, patients can regain mobility of the affected arm. Provided no serious complications occur, follow-up care for moderate radial palsy is usually completed within a few months.
Here’s what you can do yourself
To reduce impairment of muscles or nerve pathways in the body, care should be taken in posture to avoid pinching vessels or fibrous pathways as a matter of principle. Stiff or rigid physical positions should not be adopted for a prolonged period of time. In addition, no pressure should be exerted on the body by external influences. Balancing movements are important after a period of sitting or standing for good functioning of the circulatory system and the supply of nutrients and messenger substances to the organism. It is advisable for the patient to engage in various sports activities on a regular basis to maintain good health and to exercise. At the same time, one-sided physical stress should be avoided in everyday life. The extremities in particular should be protected from overloading or excessive strain. Lifting and carrying heavy objects should be avoided to prevent damage to the nerve pathways. In the case of diagnosed moderate radialis paralysis, the patient should sufficiently rest his or her arm and keep it still. In many cases, even a reduction in physical activity for several days reduces the existing discomfort. Applying heat to the affected region also helps to achieve an improvement in the impairments. In addition, it protects against further conditions such as inflammation or irritation of the nerves.