Introduction
Approximately 300,000 individuals worldwide are affected by radial nerve entrapment each year. For effective diagnosis and treatment, medical professionals must comprehensively understand the associated anatomy, neurology, and available therapeutic options. This article will explore the management of radial nerve entrapment, highlighting the importance of manual therapy and exercises such as nerve flossing.
Article Index:
Anatomy of the Radial Nerve
The radial nerve, a branch of the brachial plexus, originates from the posterior cord and carries fibres from the C5-T1 spinal nerves (2). It descends through the axilla, posterior to the humerus, and passes through the radial groove, where it is vulnerable to compression and entrapment. The radial nerve then branches into the deep branch (responsible for wrist and finger extension) and the superficial branch (responsible for cutaneous innervation of the dorsal hand) (3).
Neurological Manifestations of Radial Nerve Entrapment
Radial nerve entrapment can lead to a range of symptoms depending on the location of compression. These symptoms may include pain, weakness, and numbness in the forearm, wrist, and hand. Understanding the specific site of compression is crucial for tailoring effective treatment strategies and improving patient outcomes. Now lets consider a few of the aspects of Radial Nerve Entrapment
Common clinical manifestations of radial nerve entrapment:
Pain: A person with radial nerve entrapment may experience pain along the course of the radial nerve. This pain often presents in the forearm, particularly along the lateral (thumb) side, and can extend to the back of the hand and wrist. The pain might be sharp, aching, or burning, and it can worsen with activities involving wrist and finger extension or prolonged pressure on the forearm. Properly diagnosing the source of the pain is essential for effective treatment and relief (4).
Weakness: Weakness due to radial nerve entrapment typically affects the muscles responsible for extending the wrist and fingers, leading to difficulty in tasks requiring these movements. This can manifest as a reduced ability to straighten the wrist or fingers, often called "wrist drop." Additionally, patients may experience a weakened grip, making it challenging to hold objects or perform fine motor tasks. Identifying and addressing the site of nerve compression is crucial to restoring muscle strength and functionality (4).
Sensory Changes: Sensory disturbances along the radial nerve's distribution can manifest as tingling, numbness, or a burning sensation in the back of the hand, the thumb, and the first two fingers (4).
Sensory distribution:
Posterior arm
Forearm
Dorsum of the hand (excluding tips of the thumb, index, and middle fingers)
Muscles Innervated by the radial nerve:
Triceps
Anconeus
Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis
Potential patient presentations:
Wrist drop
Impaired finger extension
Numbness or tingling on the dorsal side of the hand and forearm (4).
Diagnosis and Assessment
Diagnosing radial nerve entrapment involves gathering a detailed patient history, conducting a comprehensive physical examination, and performing electrophysiological studies. During the physical examination, evaluating the patient's range of motion, muscle strength, and sensation in the affected limb is important. Techniques such as Tinel's sign and provocation tests can help pinpoint the exact location of the nerve compression. Additionally, electrophysiological studies, including nerve conduction studies and electromyography, offer valuable insights into the severity and precise location of the entrapment, ensuring a thorough and accurate diagnosis.
Upper Limb Neuro Exam
The complete upper limb neurological examination is a crucial aspect of the overall neurological assessment. It evaluates the motor and sensory neurons that provide functionality to the upper limbs. Its primary purpose is to identify any potential impairments or abnormalities within the nervous system. This examination serves as a screening and investigative tool, enabling healthcare professionals to better understand a patient's neurological health.
Motion Specific Release
Manual therapy offers a variety of effective techniques for treating radial nerve entrapment, including soft tissue mobilization, joint mobilizations, nerve gliding techniques, Motion Specific Release (MSR), Active Release, massage therapy, and acupuncture. A systematic review has shown that manual therapy can significantly reduce pain and disability in patients with peripheral nerve entrapments, such as radial nerve entrapment. These approaches primarily aim to alleviate pain, improve range of motion, and enhance nerve movement. For healthcare professionals seeking visual guidance, our YouTube channel features demonstration videos on soft tissue mobilization procedures and other manual therapy techniques.
MSR Radial Nerve Release
In this video, Dr. Evangelos Mylonas will demonstrate the MSR (Motion Specific Release) radial release protocol, designed to alleviate radial nerve entrapment. As a reminder, this condition commonly causes lateral elbow and forearm pain and can occur at any point along the anatomic path of the radial nerve. By following the techniques outlined in this video, healthcare professionals can effectively address radial nerve compression and help their patients relieve discomfort.
Fascial Expansion: MSR Wrist & Hand Protocol
This video demonstrates how fascial expansion techniques can effectively treat wrist and hand pain, offering a holistic approach that integrates modern understanding of fascia, kinetic chain relationships, and principles from acupuncture and traditional Chinese medicine. Specifically, we explore how fascial layers interconnect with acupuncture points like PC7, LU9, TH4, TH5, LI4, LI5, and SI4 to address and alleviate symptoms of radial nerve entrapment.
In cases involving the elbow or shoulder, we also combine these techniques with fascial expansions targeting the elbow and shoulder to provide comprehensive relief and improve overall function. This integrated approach ensures that we address the entire kinetic chain, offering a more effective treatment for radial nerve entrapment and associated discomfort.
Exercise
A comprehensive exercise program is crucial for effectively managing radial nerve entrapment. This program should include stretching, strengthening, and proprioceptive exercises to enhance flexibility, muscle balance, and joint stability. Nerve flossing, a specialized nerve gliding technique, is also an invaluable part of the exercise regimen. This technique gently moves the nerve through its full range of motion, reducing tension and promoting nerve mobility. Our YouTube channel features a video demonstrating radial nerve flossing, providing helpful guidance. Research has shown that nerve flossing can significantly reduce pain and improve function in patients with nerve entrapment syndromes, with one study reporting a 70% reduction in pain scores after six weeks of nerve flossing exercises.
Radial Nerve Flossing
If you're experiencing radial nerve entrapment syndrome, the exercises demonstrated in this video can be used to floss, mobilize, and release the radial nerve from any surrounding tissues. These techniques are designed to help alleviate the symptoms associated with radial nerve compression, ultimately promoting better nerve function and reducing discomfort.
Conclusion
In conclusion, radial nerve entrapment is a significant condition that affects approximately 300,000 people worldwide each year, causing pain, weakness, and sensory disturbances. Understanding the anatomy and neurology of the radial nerve is essential for effective diagnosis and treatment. By utilizing a combination of manual therapy techniques, such as Motion Specific Release (MSR), and comprehensive exercise programs that include nerve flossing, healthcare professionals can significantly alleviate symptoms and improve patient outcomes.
The key to successful management lies in a holistic approach that integrates thorough assessment, targeted manual therapy, and tailored exercises. Demonstration videos on our YouTube channel provide valuable guidance for practitioners, ensuring they can implement these techniques confidently and effectively. With continued research and application of these methods, we can offer patients a path to recovery and improved quality of life, demonstrating the power of a well-rounded, evidence-based treatment strategy for radial nerve entrapment.
References
Kim, D. H., Murovic, J. A., Tiel, R. L., & Kline, D. G. (2004). Management and outcomes in 353 surgically treated radial nerve lesions. Journal of Neurosurgery, 101(3), 413-420.
Standring, S. (2016). Gray's Anatomy (41st ed.). Elsevier.
Miller, T. A., & White, K. P. (2013). Radial nerve entrapment. In Nerve Entrapments (pp. 109-120). Elsevier.
Pecina, M. M., & Krmpotic-Nemanic, J. (2001). Tunnel Syndromes: Peripheral Nerve Compression Syndromes. CRC Press.
Neal, S. L., & Fields, K. B. (2010). Peripheral nerve entrapment and injury in the upper extremity. American Family Physician, 81(2), 147-155.
Preston, D. C., & Shapiro, B. E. (2013). Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations (3rd ed.). Elsevier.
Goodyear-Smith, F., & Halliwell, J. (2009). Antebrachial entrapment neuropathy. The Journal of Manual & Manipulative Therapy, 17(2), 71-85.
Binkley, J. M., Stratford, P. W., & Lott, S. A. (2009). The Lower Extremity Functional Scale (LEFS): Scale development, measurement properties, and clinical application. North American Journal of Sports Physical Therapy, 4(2), 49-57.
Coppieters, M. W., & Butler, D. S. (2008). Do “sliders” slide and “tensioners” tension? An analysis of neurodynamic techniques and considerations regarding their application. Manual Therapy, 13(3), 213-221.
Ellis, R., Hing, W., Dilley, A., & McNair, P. (2012). The effects of a home-based neurodynamic technique in symptomatic carpal tunnel syndrome: a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy, 42(8), 689-696.
Abelson, B., Abelson, K., & Mylonas, E. (2018, February). A Practitioner's Guide to Motion Specific Release, Functional, Successful, Easy to Implement Techniques for Musculoskeletal Injuries (1st edition). Rowan Tree Books.
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DR. BRIAN ABELSON DC. - The Author
Dr. Abelson is dedicated to using evidence-based practices to improve musculoskeletal health. At Kinetic Health in Calgary, Alberta, he combines the latest research with a compassionate, patient-focused approach. As the creator of the Motion Specific Release (MSR) Treatment Systems, he aims to educate and share techniques to benefit the broader healthcare community. His work continually emphasizes patient-centred care and advancing treatment methods.
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