Radial Nerve Injury at the Wrist

Aka: Radial Nerve Injury at the Wrist, Handcuff Neuropathy

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II. Pathophysiology

  1. Radial Nerve superficial branch is susceptible to injury where it crosses the volar wrist
    1. Nerve crosses over the flexor Retinaculum that encases the Carpal Tunnel
    2. Compression occurs with any item that tightly binds the wrist in this location
    3. Superficial Radial Nerve is a Sensory Nerve only (dorsal hand and wrist Sensation)

III. Causes

  1. Any compressive device at the volar wrist (e.g. handcuffs, watches)
    1. Higher risk if cuffs ride up the Forearm proximally
    2. Typically affects the dorsal branch of the Radial Nerve with Paresthesias and numbness on the back of the hand

IV. Symptoms

  1. Dorsal hand numbness or Paresthesias (especially radial aspect)

V. Signs

  1. Decreased Sensation over dorsal and radial hand, dorsal thumb, dorsal index finger
  2. Normal hand and wrist motor function

VI. Management

  1. Avoid wrist compression
  2. Consider single Corticosteroid Injection
  3. Surgery is rarely indicated
    1. May be considered for refractory course after 3-4 months of conservative therapy

VII. Course

  1. Anticipate 3 months to resolution with therapy

VIII. References

  1. Huisstede (2008) J Hand Surg Am 33(1): 72-8 [PubMed]
  2. Neal (2010) Am Fam Physician 81(2): 147-55 [PubMed]
  3. Silver (2021) Am Fam Physician 103(5): 275-85 [PubMed]

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