In upper radial palsy, paresis occurs due to damage or irritation of the radial nerve. This usually develops near the axilla. Upper radial nerve palsy is associated with various symptoms for the affected person.
What is upper radial palsy?
Upper radial palsy results from damage to the radial nerve and manifests itself in a number of symptoms. In some cases, symptoms resolve on their own after a period of time. Otherwise, therapeutic intervention is necessary, because upper radial nerve palsy significantly restricts the affected patients in their daily lives. Usually, upper radial palsy occurs in only one arm.
Causes
The causes responsible for the development of upper radial palsy are varied and may differ greatly from patient to patient. Basically, however, upper radial palsy occurs by damaging or irritating the corresponding nerve. The types of damage and their causes vary considerably. However, upper radial palsy results increasingly from certain factors. In numerous patients, paralysis of the upper radial nerve in the axillary region results from crutches, for example. In this specific case, these are usually walking aids that support the forearms. If the paresis is caused by this factor, the upper radialis paralysis is sometimes colloquially called crutch paralysis. In addition, however, there are a number of other potential causes that sometimes produce upper radial paresis. For example, paresis develops in some individuals who have a cast applied to the corresponding section of the arm. If the bandage is too tight, in some cases it damages the radial nerve. As a result, upper radial palsy develops in some patients. Trauma also sometimes results in paresis of the superior radial nerve. For example, a fracture in the head of the humerus represents such a trauma.
Symptoms, complaints, and signs
In connection with upper radial palsy, affected individuals suffer from a variety of symptoms. First, there is paresis of a specific muscle, called the triceps brachii muscle. As a result, extension of the lower arm is no longer possible. In addition, there are restrictions in the mobility of various other areas. For example, radial extension of the wrist is now only possible with difficulty on the affected arm. In addition, both abduction and extension of the ulna are impaired. Problems also arise in what is known as supination. This is due to the fact that certain muscles are affected by the paralysis, for example the supinator muscle. Other characteristic symptoms in the context of an upper radialis paralysis are, for example, a drop hand or so-called drop fingers. These terms describe the inability to extend the wrist and the joints of the fingers. In addition, the affected persons are no longer able to close their fist completely. If the lower arm is in the middle position, flexion is only possible to a limited extent. This is because the brachioradialis muscle is also affected by the paralysis. In addition, reduced triceps tendon and radius periosteal reflexes are seen in upper radialis paralysis. Disturbances in sensitivity result in certain areas of the upper and lower arm. These complaints occur because numerous nerves fail, including the lateral cutaneus brachii nerve and part of the radial nerve. If the paralysis of the superior radial nerve does not disappear after a certain time at the latest, atrophy of some muscle groups develops.
Diagnosis and course of the disease
Patients with the main symptoms of upper radial palsy are strongly advised to inform a physician about their complaints. During the history taking, the treating physician inquires about the symptoms and discusses possible causes that led to the upper radial palsy. After the patient interview, clinical examination procedures are used. Here, the physician checks whether the diseased person is able to extend and flex various sections of the arm, hand and fingers. The presence of specific reflexes indicative of upper radialis paralysis is also tested.With regard to the differential diagnosis, it is of particular importance to differentiate upper radial palsy from lower radial palsy. Electroneurography is used to confirm the diagnosis of upper radial palsy. This also provides the physician with important information about the localization of the damage to the nerve.
Complications
In this disease, the affected person suffers from paralysis. It has a very negative effect on the quality of life, and in the process can lead to significant restrictions in movement and thus also in the patient’s everyday life. Thus, for most patients, stretching the arm is no longer possible without further ado. Pain can also occur, which in many cases spreads from the arm to the fingers. Closing the fist is also no longer possible with this paralysis, so that in many cases patients are dependent on the help of other people in their daily lives. Furthermore, the disease leads to disturbances in sensitivity and a false sense of temperature. Muscles are also degraded, as they are no longer actively used. In some cases, this paralysis can also lead to depression or other psychological limitations. Young people in particular are affected by these symptoms. Usually, no direct treatment is necessary for this paralysis. With the help of sufficient rest and recuperation, the nerve can recover so that the complaints disappear. In the case of a bone fracture, surgical intervention is necessary. In this case, there are usually no complications.
When should you go to the doctor?
Restrictions on movement should always be clarified by a doctor. If the arm can no longer be moved as usual, a visit to the doctor is necessary. Muscle discomfort, limitations in physical strength or sensory disturbances should be examined and treated. If the gripping function can no longer be performed as usual, if there are numbness sensations on the skin or if the affected person suffers from hypersensitivity to perceived stimuli, a doctor must be consulted. If there is paralysis, a loss of well-being, general malaise or a feeling of illness, the affected person needs help. If everyday requirements can no longer be met or participation in usual sporting activities is not possible, investigations to clarify the cause are advisable. Sensitivity to temperature is characteristic of upper radial palsy. It should be discussed with a physician so that a treatment plan can be developed. If additional emotional discomfort develops as a result of the physical impairment, there is also cause for concern. If there are mood swings, behavioral problems, or withdrawal from social life, observations should be discussed with a physician or therapist. If the affected person suffers from a depressed mood or if there is an aggressive demeanor, these are often secondary symptoms of a physical disorder. A physician should be consulted as soon as the abnormalities persist over a longer period of time or increase.
Treatment and therapy
In connection with upper radial palsy, the treatment measures depend primarily on the triggering cause of the paresis. If the upper radial palsy is the result of excessive exposure to pressure for too long, the prognosis is usually comparatively favorable. The radial nerve usually recovers after some time and the upper radial palsy disappears by itself if the affected arm is temporarily not loaded. The situation is different in the case of damage to the nerve after bone fractures. In such cases, surgical intervention is often necessary. This allows the interruption in the course of the nerve to be reconstructed.
Outlook and prognosis
In general, the prognosis for upper radial nerve palsy is favorable. In many cases, spontaneous healing can be documented. This results in a regression of the health irregularities that have occurred. This is often the case when the affected person temporarily uses walking aids in which the forearms are supported. As soon as the walking aids are no longer used, the paralysis symptoms regress. The same development is seen in patients who wear a plaster cast. When this is removed, complete recovery from upper radial paralysis also occurs in them. If the course is difficult, further examinations are necessary.Here, further development depends on the present cause. In unfavorable conditions, surgical intervention is necessary. This is usually the case in patients with a bone fracture or damage to the nervous system. If the operation proceeds without complications, a complete recovery can also be expected after the wound has healed. In many cases, physiotherapeutic support is recommended. This allows the affected person to optimize movement sequences and better adapt them to the current possibilities. This is particularly useful if renewed damage to the nerve pathway is to be ruled out in the future. In order to avoid long-term impairments of the movement possibilities as well as possible after-effects, cooperation with a physician should always take place. In this way, the causes can be fully clarified even in the case of spontaneous healing.
Prevention
Upper radial palsy is preventable by not overloading the arm. This is because this may damage the radial nerve.
Aftercare
Depending on whether the clinical picture arose spontaneously, due to external influences, or after surgery with reconstruction of the affected nerves, aftercare is tailored to the patient. In all cases, incorrect postures of the body as well as one-sided stresses should be avoided and, if necessary, corrected by physiotherapy. The symptoms can lead to considerable restrictions, especially in everyday life. Affected persons should not be afraid to ask for help from family, friends or a called-in nurse. In cooperation with the physician and the physiotherapist, the patient experiences numerous assistance measures and can thus increasingly improve his or her own body coordination in the course of follow-up care. Light sporting activities support the muscular system. Due to the unconscious protective posture, patients are often additionally prone to muscle hardening. Medically applied massages can help to loosen the hardenings that have developed and at the same time promote blood circulation in these regions. Some patients specifically find moderate sauna sessions (maximum 80 degrees) or a visit to the infrared cabin to be soothing. A balanced low-fat diet as well as a stress-free lifestyle positively support the aftercare therapy. During healing and also after symptom improvement, extreme sports and heavy carrying should be avoided. One-sided sitting for too long should be regularly interrupted by specific loosening-up exercises. Also beneficial is an orthopedic mattress for restful sleep.
What you can do yourself
One-sided loads or incorrect postures of the body should be avoided or corrected as soon as possible. If the affected person needs help in everyday life to regulate the optimal movement patterns, consultation with a doctor or physiotherapist is advisable. Optimizations and improvements in coordination can be worked out in collaboration with trained personnel. Care should be taken that the body shows limits when carrying bags or working in a seated position, which should be taken as a warning. Regular exercise will support the muscular system. In addition, massages or specific loosening exercises can help to loosen possible hardening of the muscle fibers. Care should be taken to avoid extreme sports. Balancing movements are important so that no tensions or overloads occur. The workplace as well as sleep hygiene should be checked and optimized if necessary. Since the paralysis leads to a restriction in the performance of daily tasks, it is necessary to restructure everyday life. The support of people from the close environment should be taken up thereby. To strengthen the joy of life and well-being, it is important that leisure activities take place that fulfill the affected person emotionally. This prevents possible psychological or emotional stress. This prevents secondary diseases on the psychological level.
