Have you ever felt pins and needles in your leg when you sit down in the same place for too long? This strange sensation is a sign of a mild nerve compression. While we are awake, these compressions are easily resolved, as we can recognize the symptoms and adjust our body position accordingly. While we are asleep, however, we cannot always respond to these compressions, which can cause consequences during waking hours. We will be focusing on nighttime compression of the radial nerve, which may lead to a condition called radial nerve palsy.
The radial nerve is one of the three major nerves that sense feeling and control the muscles in your arm. It travels from your neck and down the back of your arm all the way into the hand. The muscles controlled by the radial nerve allow you to straighten out your elbow, extend your wrist up as if getting ready to throw a dart, and even make a “thumbs up” sign.
Prolonged compression of the radial nerve can happen in many ways, usually due to pressure being placed on the armpit, since this is where the nerve enters the arm as it exits the neck. Radial nerve compression most often happens while sleeping with your head resting on your outstretched arm. If you sleep in a position that causes radial nerve compression, you may wake up experiencing numbness and tingling along the back of your arm, forearm, and hand. With more severe compression, you may also experience “wrist drop”. With wrist drop, your wrist becomes limp, and is unable to extend up. This can cause significant functional problems, making it difficult to lift even small items in your hand.
Think of a nerve like a highway and nerve signals like cars. A healthy nerve (the highway) will allow nerve signals (the cars) to flow freely, allowing you to control your muscles. A nerve compression is like traffic on that highway, meaning that nerve signals won’t get to reach the muscles, causing weakness and a loss of muscle control.
After proper diagnosis from a physician, you will most likely see a certified hand therapist (CHT). It may take several weeks to heal from a radial nerve palsy, and a CHT will be able to monitor progress and facilitate functional use of your hand during the healing process. If you have wrist drop, a CHT can make you a custom splint that will keep your wrist straight and allow you to bend your fingers. This type of splint will protect the joints in your wrist and hand from becoming contracted if you have wrist drop and allow you to continue using your hand to grasp objects while the nerve heals. Your hand therapist will also design a program of exercises that will help you continue to perform your daily activities and eventually regain strength in your hand and wrist.
To find a hand therapist near you, consult your physician, or use the Find a Therapist Directory at www.ASHT.org.
Wrist drop, a potential consequence of radial nerve palsy.