Procedures · Peripheral Nerve & Brachial Plexus Surgery

Radial Nerve Injury

Medically reviewed by Dr. Khalid Almutairi, Consultant Plastic Surgeon — updated 2026-08-13

The radial nerve is the hand's "opening" motor: it lifts the wrist, straightens the fingers, and sets the hand up to grasp. Its injury produces the recognisable picture of wrist drop — a hand hanging at the wrist, unable to raise its fingers. Grip itself weakens too: not because the gripping muscles fail, but because a strong grip needs a stable, lifted wrist.

Care is led by Dr. Khalid Almutairi, a consultant plastic and reconstructive surgeon, fellowship trained in hand surgery and microsurgery in Canada and the USA.

How is it injured?

The radial nerve winds around the humerus in a groove that hugs the bone — and that position is the key to its injuries:

• Humerus fractures: the most common cause; the nerve can be stretched or trapped with the fracture or during its treatment.
• Prolonged pressure: deep sleep in a position compressing the arm — the pattern known as "Saturday night palsy" — mostly a recoverable compression.
• Sharp, deep wounds of the arm or forearm.
• Injuries higher up in the brachial plexus — which has its own page.

Why is this particular injury often optimistic?

Radial nerve injuries carry three advantages: many are compressions or stretches that recover spontaneously over weeks to months; the target muscles are relatively close, so regeneration reaches them in useful time; and even in the worst cases, this nerve owns the most successful and well-established tendon-transfer solutions in hand surgery. Optimism does not mean complacency — it means early assessment that sets each case on its correct path.

Assessment and follow-up

Examination localises the injury from the map of weakened muscles and the area of numbness on the back of the hand, and recovery is tracked with repeated examinations — returning muscles progress from above downwards in a known order that marks the advance of regeneration. Electrodiagnostic studies (NCS/EMG) are used where needed to distinguish a recovering compression from a division needing surgery, and to detect reinnervation before it is clinically visible.

While waiting: the hand is not left to stiffen

The waiting period is not a treatment vacuum. A dynamic splint lifts the wrist and fingers and temporarily returns much of the hand's function, and daily exercises keep the joints fully supple — because the muscle the nerve will eventually reach needs free joints to work through. This is a precondition for the success of every later pathway.

Surgical options

The tool is chosen by the type and timing of the injury:

• Exploration and neurolysis: when the course suggests a nerve trapped in scar or between fracture fragments.
• Direct repair or grafting: for sharp divisions, following the usual principles of nerve surgery.
• Nerve transfer: in selected cases, redirecting a spareable healthy branch toward the target muscles to shorten the regeneration distance.
• Tendon transfer: the established solution for stable paralysis whose repair window has passed — working tendons from the flexor side are re-purposed to lift the wrist and extend the fingers and thumb. Its functional results are among the best of all tendon transfers, and it has its own page.

Recovery and expectations

On the spontaneous-recovery and nerve-repair pathways, improvement extends over months and is measured by the ordered return of the muscles. With tendon transfer, the new movement appears after the protection period and is refined by training. A complete return cannot be guaranteed in every case, but functional recovery of wrist lift and finger opening is a realistic goal for most patients on the appropriate pathway.

Limitations and risks

Risks include incomplete recovery, residual numbness on the back of the hand — functionally less consequential than palm numbness — and the known risks of tendon transfer such as adhesion and tension imbalance, in addition to general surgical risks. The risks relevant to your pathway are discussed before any decision.

I woke up with a dropped wrist and no injury — what should I do?

This pattern is usually a recoverable compression, but it deserves assessment to exclude other causes and to set up the follow-up, splint, and exercises — not silent waiting.

How long is spontaneous recovery awaited before surgery?

No single period fits all cases; the decision is built on the injury type, the progress of clinical signs, and serial studies. Regular follow-up is what calibrates the timing — not the calendar alone.

Is tendon transfer still available years later?

Yes, in many cases; it does not depend on the nerve-regeneration window. It requires supple joints and suitable donor tendons — which is what examination determines.

Medical-information notice

This is general information and does not replace consultation and examination. A new wrist drop after a fracture or wound needs urgent assessment as part of treating the injury itself.