Radial Nerve Palsy After Proximal Humerus Fracture Surgery

Fracture of the left proximal humerus and humeral shaft, left radial nerve palsy?

Hello, Doctor.
I was in a car accident on April 10, and the diagnosis indicated that I underwent minimally invasive surgery with self-paid bone graft and titanium alloy intramedullary nail.
When I was discharged on April 15, the doctor mentioned that my radial nerve palsy was somewhat unusual, as he had not seen a case of persistent radial nerve palsy after minimally invasive surgery, but he assured me that it would heal.
A few days after discharge, I have been experiencing a tingling sensation in the back of my index finger, the back of my thumb, and the back of my hand, similar to the feeling after a nap.
In addition to the tingling, there is also a significant pain sensation.
My follow-up appointment is next week, but since the pain is quite intense, I would like to ask if this is a normal phenomenon.
I am concerned because my humeral shaft is in three segments, and I worry if there is indeed an issue with the nerve.
Generally, when I read online, it seems that nerve pain is not commonly reported; usually, it is just the wrist and fingers that do not respond, so I am worried that having pain sensation might not be normal.
Thank you.

Zhuo, 20~29 year old female. Ask Date: 2021/04/16

Dr. Chen Bochen reply Orthopedics

Hello Doctor, I was in a car accident on April 10th, and the diagnosis indicated that I underwent minimally invasive surgery with self-paid bone graft and titanium alloy humeral intramedullary nail.
Upon discharge on April 15th, the doctor mentioned that my radial nerve palsy was somewhat unusual, as he had not seen cases where the radial nerve remained affected after minimally invasive surgery, but he assured me that it would heal.
It is quite common to experience numbness before the surgery and to still have it afterward.
Generally, about 70-80% of radial nerve injuries can recover on their own.

A few days after discharge, I have been feeling a numb sensation on the back of my index finger, thumb, and hand, similar to the feeling after a nap.
In addition to the numbness, there is also a significant pain sensation.
My follow-up appointment is next week, but the pain has become quite intense, so I would like to ask if this is a normal phenomenon.
I am concerned because my humeral shaft is in three segments, and I worry if there is indeed a problem with the nerve.
From my research, it seems that nerve pain is not commonly reported; usually, it’s just the wrist and fingers that show no response, so I am worried that having pain sensation might not be normal.
Thank you.

Severe radial nerve injury can lead to wrist drop, while milder cases may present as numbness and pain.
If the symptoms are only numbness and pain, it is also important to consider whether there is an injury to the branches of the radial nerve in the forearm.

Reply Date: 2021/04/16

More Info

Radial nerve palsy following a proximal humerus fracture surgery can be a concerning complication, and your symptoms warrant careful consideration. After a traumatic injury like a car accident, the radial nerve can be affected due to direct trauma, swelling, or even compression from surrounding tissues or surgical hardware.
In your case, the fact that you are experiencing numbness and pain in the dorsal aspect of your thumb and index finger, as well as the back of your hand, suggests that the radial nerve may indeed be involved. The sensation of numbness or tingling, often described as a "pins and needles" feeling, is typically associated with nerve irritation or damage. The pain you are experiencing, especially if it feels sharp or burning, could indicate neuropathic pain, which is a common issue in cases of nerve injury.

It is important to understand that nerve recovery can be a slow process. In many cases, if the nerve is merely compressed or bruised, it may recover fully over time. However, if there is significant damage, such as a complete transection of the nerve, recovery may be incomplete or require surgical intervention. The timeline for recovery can vary widely; some patients may begin to see improvement within weeks, while others may take months.

Given that your surgeon mentioned that your case is unique and that they have not seen persistent radial nerve palsy after such a procedure, it is crucial to maintain open communication with your healthcare team. You should definitely discuss your symptoms in detail during your upcoming follow-up appointment. It may be beneficial to ask about the following:
1. Nerve Conduction Studies: These tests can help assess the function of the radial nerve and determine if there is ongoing nerve damage or if the nerve is beginning to recover.

2. Physical Therapy: Engaging in physical therapy can help improve mobility and strength in your arm and hand. A therapist can also provide exercises to help stimulate nerve recovery.

3. Pain Management: If your pain is severe, it may be worth discussing additional pain management strategies. This could include medications specifically for neuropathic pain, such as gabapentin or pregabalin, which can help alleviate nerve pain.

4. Monitoring for Improvement: Keep track of any changes in your symptoms, including improvements or worsening of numbness, tingling, or pain. This information can be valuable for your doctor in determining the best course of action.

5. Surgical Options: If there is significant concern about the integrity of the radial nerve, your doctor may consider further imaging studies or even surgical exploration to assess the nerve's condition.

In summary, while it is not uncommon to experience pain and altered sensations following radial nerve injury, it is essential to monitor your symptoms closely and communicate with your healthcare provider. They can provide the best guidance based on your specific situation and help you navigate the recovery process. Remember, nerve recovery can take time, and patience is often required.

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