Abstract
Background:
Radial neuropathy is a common aetiology of wrist drop, usually arising from compression, trauma, or iatrogenic injury. The precise localisation of the lesion by electrophysiological tests is essential for diagnosis and therapy. This study seeks to assess the clinical patterns, aetiologies, and electrophysiological characteristics of radial neuropathy manifesting as wrist drop in a tertiary care setting.
Methods:
This retrospective observational study was performed in the Department of Neurology, MTI Lady Reading Hospital, Peshawar, over three years from January 2022 to December 2024. Adult patients (≥18 years) diagnosed with wrist drop attributable to radial neuropathy were included based on clinical and electrophysiological criteria. Demographic data, clinical presentations, aetiologies, imaging results, and nerve conduction investigations were gathered and analysed by descriptive and inferential statistics.
Results:
A total of 68 patients participated, comprising 48 males (70.6%) and 20 females(31.4%) females with a mean age of 42.3 ± 15.2 years. The right arm was predominantly afflicted in 39 patients (57.4%). The predominant cause was compression neuropathy in 26 patients (38.2%), with “Saturday night palsy” constituting  17 of these cases (65.4%), followed by trauma in 18 patients (26.5%) and iatrogenic injuries in 12 patients (17.6%). High radial nerve palsy was the predominant lesion location in 42 patients  (61.8%), followed by posterior interosseous nerve syndrome in 20 patients (29.4%) and radial tunnel syndrome in 6 patients (8.8%). Electrophysiological investigations validated the localisation and severity of the lesion. Imaging was conducted in 32 patients, 47.1% of patients, demonstrating nerve compression or signal alterations in the majority of instances. All patients received conservative treatment; early diagnosis was substantially correlated with expedited recovery (p < 0.05).
Conclusions:
Radial neuropathy primarily results from external compression, particularly during sleep-related positions. Electrophysiological studies are crucial for the diagnosis and differentiation of lesion types. Conservative management produces positive results, especially when implemented early. Additional prospective studies are necessary to assess long-term prognosis and improve treatment strategies.
Keywords:
Radial nerve palsy, Wrist drop, Compression neuropathy, Electrophysiology, Saturday night palsy, Posterior interosseous nerve syndrome, Nerve conduction studies, Peripheral nerve injury.