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Untangling the Knot: Understanding and Treating Radial Nerve Entrapment

Updated: Dec 5, 2023

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.


Article Index:

 

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).


 

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.


 

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.


 

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.


 

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.


 

DR. BRIAN ABELSON DC. - The Author


Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.

 


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


  1. 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.

  2. Standring, S. (2016). Gray's Anatomy (41st ed.). Elsevier.

  3. Miller, T. A., & White, K. P. (2013). Radial nerve entrapment. In Nerve Entrapments (pp. 109-120). Elsevier.

  4. Pecina, M. M., & Krmpotic-Nemanic, J. (2001). Tunnel Syndromes: Peripheral Nerve Compression Syndromes. CRC Press.

  5. Neal, S. L., & Fields, K. B. (2010). Peripheral nerve entrapment and injury in the upper extremity. American Family Physician, 81(2), 147-155.

  6. Preston, D. C., & Shapiro, B. E. (2013). Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations (3rd ed.). Elsevier.

  7. Goodyear-Smith, F., & Halliwell, J. (2009). Antebrachial entrapment neuropathy. The Journal of Manual & Manipulative Therapy, 17(2), 71-85.

  8. 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.

  9. 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.

  10. 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.

  11. 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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