Radial Nerve Lesions

1. Low lesions
a. Usually due to fractures or dislocations at the elbow, or to a local wound.
b. Iatrogenic lesions of the posterior intraosseus nerve where it winds through the
supinator muscle are sometimes seen after operations on the proximal end of the
radius.
c. Clumsiness, on testing cannot extend the metacarpophalangeal joints of the hand.
d. In the thumb there is also wakness of extention and retroposition.
e. Wrist extention is preserved because the branch to the extensor carpi radialis
longus arises proximal to the elbow.

2. High lesions
a. Occur with fractures of the humerus or after prolonged tourniquet pressure.
b. Wrist drop due to weakness of the radial extensors of the wrist.
c. Inability to extend the metacarpophalangeal joints or elevate the thumb.
d. Sensory loss is limited to a small patch on the dorsum around the anatomical
snuffbox.

3. Very high lesions

a. May be caused by trauma or operations around the shoulder.
b. More often due to chronic compression in the axilla.
c. Seen in drink and drug addicts who fall into stupor with the arm dangling over the
back of a chair (Saturday night palsy)
d. Or seen in the elderly patients using crutches (Crutch palsy)
e. Weakness of the wrist and hand, triceps is paralysed, triceps reflex is absent.