Examination of Radial Nerve and viva


Not to miss following points during the examination

Attitute of the limb


Look - Wrist Drop

             Elbow semiflexed

           any scars on arm , forarm

          any muscles wasting


Feel - temperature

           any soft tissue or bony tenderness

           tinel's sign ,scar tenderness , scar pliability

Movement

          active and passive

Measurement if any angulation or bony deformity


Neurovvascular examination

sensation of autonomous zones of hands and  direct the examination to the nerve affected

Power of muscles - Examine both the weaker muscles and donor group of muscles


          Arm - Triceps function


  Elbow - Brachioradialis

              Pronator Teres

             Supinator

Wrist      ECRL

             ECRB

           ECU


           PL / FCU / FCR



Reflexes

Pulsation

Special tests - ligament laxity





How do you confirm that its radial nerve injury ?

Humerus shaft fracture or dorsoradial fracture

 Deficits

           Wrist extension

            thumb extension and abduction

             finger MCP extension

More distal radial injuries
   
              low radial nerve palsy

              preserved wrist extension

             loss of thumb extension , abduction and finger MCP joint extension




Treatement -

Observe - closed humeral fracture


Surgery - in absence of recovery or no advancing tinel's sign at 3 months

                radial nerve  neurorraphy (outcome before 6 months )

                Tendon transfer - post pone for 6 months


Burkhalter indications

1.To act as a substitute during regrowth of nerve , avoids external splints

2. to act as a helper

3. to intervene when results of nerve repair poor or irrepairable

Low Radial Nerve Palsy

P3 forearm fractures


Different Tendon Transfer

Jone's -


Brand -


Boyes -


Tsugen -



















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