Inflamed Superficial Branch of the Radial Nerve

Patient profile: 

  • 46-year-old male (right hand dominant), who injured his right wrist on 12/17/2018. 
  • He is an active male who goes to the gym 3-5 times weekly for high-load weight training. 
  • He has a significant history of competitive level hockey. 
  • His medical history is significant for a hip replacement in 2018 and surgery on his lower spine in 2004. 
  • He has no chronic illness that requires medication. 
  • He has been treated recently for insertional bicep tendonitis.
  • He is on a high protein diet and does not take any prescription medication. 
  • Occupation does not involve physical activity.
  • He does not have any underlying gut health issues at present and maintains healthy body weight.  

 

Symptoms: 

Weight Bearing tolerance decreased subjectively by 50% following the onset of the injury on the right-hand wrist. Radial side discomfort at 2 inches proximal of flexor carpi radialis tendon insertion. Distal biceps tendon discomfort and pain when loading in flexed elbow position which resembles cross-body hammer curls.

Test Results:

Weight-bearing tolerance: Both wrists are equal at 77 lbs. 

X-Ray - Wrist: No injury detected Jan 29, 2020. 

Blood:

Negative for rheumatic arthritis
Thyroid and cholesterol levels are almost at optimum
Calcium within range 2.39 (2.10-2.60)
Magnesium within range 0.87 (.63-.98) Low
Vitamin D out of range 71  (75-150)  Low 

Suspected mechanism of injury: 

Performing cross-body hammer curls with shoulder adducted and flexed with wrist supinated.   

Additional diagnostic tests and information:

  • Patient blood work was done and revealed Vitamin D and Magnesium deficiency.
  • Weight Bearing tolerance improved significantly from the onset of symptoms up to when the consultation was done.
  • The patient had slight discomfort whilst wearing the WristWidget during activities.  The superficial branch of the radial nerve is irritated and can be recaptured with stretch to the skin distally at the branch of the radial nerve, 2 inches proximal to the radial styloid. 
  • When it is Kinesio taped proximally to the elbow, his weight bearing symptoms resolve. 

Treatment plan 

The patient will take supplements to address the deficiency in Magnesium and Vitamin D.  Balanced diet was maintained with no alteration to protein intake. 

Strength training and exercise routine were adapted. He is to cease all bicep curls.  He is to tape the skin (as shown) at the superficial branch of the radial nerve proximally, placing the tape distally and pulling it proximally past the bicep insertion to retrain the radial nerve.  

Strengthening of the triceps/anconeus muscle groups through the full extension of the elbow will help stabilize the proximal portion of the radial nerve.  

He was instructed to heat the forearm prior to exercise and stretch the elbow into full extension post-exercise training. 

He was instructed to perform a progressive load. 

Follow up results:  

No pain with weight-bearing tolerance.  No pain with load at the gym. Bicep pain resolved.  Return to prior work out routine.  

Duration of treatment:

From initial consultation to return to full activity - 8 weeks