The guidelines outlined by the New York State Workers Compensation Board present fundamental principles for addressing Radial Nerve Entrapment. These directives are designed to assist healthcare professionals in identifying appropriate therapeutic approaches within the context of a comprehensive assessment.
Healthcare professionals with expertise in managing Radial Nerve Entrapment can depend on the guidance provided by the Workers Compensation Board to make well-informed decisions about the most suitable therapeutic methods for their patients.
It is crucial to emphasize that these guidelines are not meant to substitute clinical judgment or professional expertise. The final decision regarding the management of Radial Nerve Entrapment should involve collaboration between the patient and their healthcare provider.
Radial Nerve Entrapment
Radial nerve entrapment often manifests as radial nerve palsies affecting the hand and wrist. It commonly occurs along the arm and forearm, proximal to the wrist, with symptoms such as sensory issues, pain along the nerve course, wrist extensor weakness, and wrist drop.
Medical History
Inquiries into sensory symptoms should be incorporated into the medical history, considering pain along the nerve course, wrist extensor weakness, and wrist drop.
Diagnostic Studies
Electrodiagnostic Studies
Recommended for confirming suspicions of radial nerve motor neuropathy. These studies should be conducted by well-trained electrodiagnosticians, preferably certified by the American Board of Electrodiagnostic Medicine.
Ultrasound (Diagnostic)
Not recommended to confirm suspicions of radial nerve neuropathy.
Medications
For most patients, first-line medications include ibuprofen, naproxen, or other older-generation NSAIDs. Acetaminophen may be an alternative for those not suitable for NSAIDs. Evidence suggests NSAIDs are as effective as opioids for pain relief and less impairing.
NSAIDs for Treatment of Acute, Subacute, or Chronic Radial Nerve Compression Neuropathy
Recommended for treating acute, subacute, or chronic radial nerve compression at the wrist. Over-the-counter agents should be attempted first. Use may be as-needed for many patients.
Indications for Discontinuation: Resolution of symptoms, lack of efficacy, or development of adverse effects.
NSAIDs for Patients at High Risk of Gastrointestinal Bleeding
Recommended for patients at high risk of gastrointestinal bleeding, with considerations for cytoprotective medications. This includes individuals with a history of prior gastrointestinal bleeding, elderly, diabetics, and cigarette smokers.
Indications for Discontinuation: Intolerance, adverse effects, or discontinuation of NSAID.
NSAIDs for Patients at Risk for Cardiovascular Adverse Effects
Patients with cardiovascular disease or multiple risk factors should discuss the risks and benefits of NSAID therapy. Acetaminophen or aspirin is considered safer regarding cardiovascular adverse effects.
Acetaminophen for Treatment of Radial Nerve Compression Neuropathy Pain
Recommended for treating radial nerve compression neuropathy pain, especially for patients with NSAID contraindications. All patients, including those with acute, subacute, chronic, or post-operative pain, may use it on an as-needed basis.
Indications for Discontinuation: Resolution of pain, adverse effects, or intolerance.
Not recommended for acute, subacute, or chronic radial nerve entrapment pain. However, opioids are suggested for limited use (up to seven days) for postoperative pain management as adjunctive therapy.
Indications: Brief prescription for post-operative pain management, especially nocturnally.
Frequency/Duration: Prescribed as needed throughout the day, tapering off gradually.
Rationale for Recommendation: Opioids may be helpful for inadequate pain relief with NSAIDs, especially for nocturnal use. Limited use is advised for postoperative patients, primarily at night for sleep.
Treatment Options
Splinting
Wrist Extension or Thumb Spica Splint
Recommended for treating acute, subacute, or chronic radial nerve compression neuropathy.
Rehabilitation
Rehabilitation following a work-related injury should aim to restore functional ability for daily and work activities, striving to return the injured worker to pre-injury status.
Active therapy requires internal effort from the patient to complete exercises, while passive therapy relies on modalities delivered by a therapist. Passive interventions complement active therapy for objective functional gains. Emphasis should be on active interventions, and patients are advised to continue both active and passive therapies at home for sustained improvement. Assistive devices may be included in the rehabilitation plan to facilitate functional gains.
Active Therapy
Therapeutic Exercise – Acute
Recommended in select patients to maintain supple joints while awaiting spontaneous recovery of nerve function.
Therapeutic Exercise – Post-Operative
Recommended for post-operative patients to keep paralyzed joints supple while awaiting nerve function recovery.
Frequency/Dose/Duration: The total number of visits may range from two to three for mild deficits to 12 to 15 for severe deficits, with documentation of ongoing objective functional improvement. If ongoing deficits persist, more than 12 to 15 visits may be necessary, guided by documentation of functional improvement towards specific goals. A home exercise program should be developed and performed in conjunction with therapy.
Passive Therapy
Ice – Self-application
Recommended for treating acute, subacute, or chronic radial nerve entrapment.
Heat – Self-application
Recommended for treating acute, subacute, or chronic radial nerve entrapment.
Mobilization / Immobilization
Not recommended for treating acute, subacute, or chronic radial nerve entrapment.
Iontophoresis
Not recommended for treating acute, subacute, or chronic radial nerve entrapment.
Acupuncture
Not recommended for treating acute, subacute, or chronic radial nerve entrapment.
Massage
Not recommended for treating acute, subacute, or chronic radial nerve entrapment.
Surgery
Surgical Release
Recommended for subacute or chronic cases of radial nerve compression neuropathy that persist despite other interventions.
Rationale for Recommendation: Recommended for select patients who failed trials of other non-operative treatments or if space-occupying lesions are present.
