Untangling the Knot: Understanding and Treating Radial Nerve Entrapment
Updated: Nov 7
Introduction
Patients frequently experience discomfort and functional impairment due to radial nerve entrapment, which is thought to affect 3.8 out of every 100,000 people annually (1). Medical experts must have a thorough awareness of the relevant anatomy, neurology, and accessible therapies in order to identify and treat this problem effectively. The management of it will be covered in this article, along with the role of manual therapy and exercise, such as nerve flossing.
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Anatomy of the Radial Nerve
The radial nerve, a branch of the brachial plexus, originates from the posterior cord and carries fibers 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:
Common clinical manifestations:
Pain
Weakness
Sensory disturbances along the radial nerve's distribution
Sensory distribution:
Posterior arm
Forearm
Dorsum of the hand (excluding tips of thumb, index, and middle fingers)
Innervated muscles:
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).
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Diagnosis and Assessment
Diagnosing radial nerve entrapment requires a thorough patient history, physical examination, and electrophysiological studies. Key aspects of the physical examination include assessing the patient's range of motion, muscle strength, and sensation in the affected limb. Tinel's sign and provocation tests can also be useful in localizing the site of compression (5). Electrophysiological studies, such as nerve conduction studies and electromyography, can provide further information on the location and severity of the entrapment (6).
Upper Limb Neuro Exam
The complete upper limb neurological examination is a crucial aspect of the overall neurological assessment, aimed at evaluating 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 both as a screening and investigative tool, enabling healthcare professionals to gain a better understanding of a patient's neurological health.
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Motion Specific Release
Manual therapy, which includes various techniques such as soft tissue mobilization, joint mobilizations, nerve gliding techniques, Motion Specific Release (MSR), Active Release, massage therapy, and acupuncture, can be an effective treatment option for radial nerve entrapment. A systematic review found that manual therapy was effective in reducing pain and disability in patients with peripheral nerve entrapments, including radial nerve entrapment (7). The primary goals of these approaches are to alleviate pain, enhance range of motion, and facilitate nerve movement. Dr. Brian Abelson has demonstration videos on his YouTube channel showcasing soft tissue mobilization procedures and other manual therapy techniques, providing valuable visual guidance for healthcare professionals.
MSR Radial Nerve Release
In this video, Dr. Evangelos Mylonas will be demonstrating the MSR (Motion Specific Release) radial release protocol, which is 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 find relief from discomfort.
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Exercise
A comprehensive exercise program is essential for the successful management of radial nerve entrapment. This should include stretching, strengthening, and proprioceptive exercises to improve flexibility, muscle balance, and joint stability (8). Nerve flossing, a specific type of nerve gliding technique, is also a valuable component of the exercise program. This technique involves gently moving the nerve through its full range of motion to alleviate tension and promote nerve mobility (9). Dr. Brian Abelson's radial nerve flossing video on YouTube provides a helpful demonstration of this technique. Research has demonstrated that nerve flossing can be effective in reducing pain and improving function in patients with nerve entrapment syndromes, with one study reporting a 70% reduction in pain scores after 6 weeks of nerve flossing exercises (10).
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 specific techniques are designed to help alleviate the symptoms associated with radial nerve compression, ultimately promoting better nerve function and reducing discomfort.
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Conclusion
Radial nerve entrapment is a common condition that requires a thorough understanding of relevant anatomy, neurology, and treatment options by healthcare professionals. Accurate diagnosis through patient history, physical examination, and electrophysiological studies is critical for effective management. Manual therapy techniques, such as soft tissue mobilization, joint mobilizations, nerve gliding, MSR, Active Release, massage therapy, and acupuncture, have all shown to be effective in reducing pain and disability in radial nerve entrapment patients.
In addition, a well-rounded exercise program that includes stretching, strengthening, proprioceptive exercises, and nerve flossing, as demonstrated in Dr. Brian Abelson's YouTube videos, plays a vital role in improving flexibility, muscle balance, joint stability, and promoting nerve mobility. Employing a multidisciplinary approach to treatment can significantly improve patient outcomes and enhance their overall quality of life. By working collaboratively, healthcare professionals can help their patients effectively manage radial nerve entrapment and address any underlying issues that may be contributing to their symptoms.
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DR. BRIAN ABELSON DC. - The Author
Dr. Abelson is committed to running an evidence-based practice (EBP) incorporating the most up-to-date research evidence. He combines his clinical expertise with each patient's specific values and needs to deliver effective, patient-centred personalized care.
As the Motion Specific Release (MSR) Treatment Systems developer, Dr. Abelson operates a clinical practice in Calgary, Alberta, under Kinetic Health. He has authored ten publications and continues offering online courses and his live programs to healthcare professionals seeking to expand their knowledge and skills in treating musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.
Despite being in the field for over three decades, Dr. Abelson remains open to welcoming new patients at Kinetic Health, save for the periods he dedicates to teaching or enjoying travels with his cherished wife, Kamali. However, be forewarned, he will anticipate your commitment to carry out the prescribed exercises and punctuality for your appointments (smile). His dedication towards your health is absolute, particularly in ensuring that you can revel in life unimpeded. He genuinely delights in greeting both new faces and familiar ones at the clinic (403-241-3772).
Revolutionize Your Practice with Motion Specific Release (MSR)!
MSR, a cutting-edge treatment system, uniquely fuses varied therapeutic perspectives to resolve musculoskeletal conditions effectively.
Attend our courses to equip yourself with innovative soft-tissue and osseous techniques that seamlessly integrate into your clinical practice and empower your patients by relieving their pain and restoring function. Our curriculum marries medical science with creative therapeutic approaches and provides a comprehensive understanding of musculoskeletal diagnosis and treatment methods.
Our system offers a blend of orthopedic and neurological assessments, myofascial interventions, osseous manipulations, acupressure techniques, kinetic chain explorations, and functional exercise plans.
With MSR, your practice will flourish, achieve remarkable clinical outcomes, and see patient referrals skyrocket. Step into the future of treatment with MSR courses and membership!
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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