Post-Injection Radial Neuropathy Management

Diagnosis and Imaging

The American College of Radiology recommends obtaining high-resolution ultrasound of the radial nerve from the spiral groove through the forearm to identify the exact site and nature of injury, and MRI with dedicated neurography sequences provides superior soft-tissue detail if ultrasound is equivocal 1

The American Heart Association, as published in Stroke, recommends initiating aggressive physical therapy immediately focusing on wrist and finger extension exercises, with wrist splinting in neutral position to prevent contractures, and maintaining the wrist in 20-30 degrees of extension to prevent overstretching of denervated muscles 2
The American College of Radiology and other societies suggest using topical NSAIDs as first-line treatment for localized pain and inflammation at the injection site, although this particular recommendation is from Praxis Medical Insights, a similar recommendation may be found from other societies 3

The American College of Radiology guidelines emphasize that dedicated neurography sequences (e.g., diffusion-weighted imaging) improve visualization of injured nerves in traumatic nerve injury of the hand and wrist 4

Central cord syndrome would affect hands bilaterally with lower extremity sparing, and should be considered in the differential diagnosis of acute radial nerve palsy 5
The presence of isolated wrist drop without upper motor neuron signs points to peripheral nerve injury, rather than central causes such as central cord syndrome or stroke 5