Radial Nerve

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Radial nerve ( तंत्रिका )
- origin and root value
  - from brachial plexus ( posterior fibers )
    - as a terminal branch of posterior cord ( पश्च रज्जु )
  - C5, C6, C7, C8 and T1
- Course
  - Arm
    - travels behind 3rd part of axillary artery ( काख के तीसरे भाग के पीछे )
    - runs behind brachial artery ( भुजा धमनी के पीछे )
    - enters lower triangular space ( निम्न त्रिकोण )
      - to reach radial sulcus of back of humerus ( पीछे परिखा में जाता हैं )
        
        here it gives muscular branches to triceps brachii ( मांस को एक शाखा )
      - after emrgence from radial sulcus ( परिखा से निकालने पर )
        
        it gives brachialis, brachioradialis and extensor carpi radilis longus
      - travels together with profunda brachii artery ( गमभीर भुज धमनी के साथ )
        
        between lateral and medial head of triceps ( त्रिशिरस्य के दो सिर के बीच में से )
        
        until it reaches lateral side of arm ( पार्श्व स्थान पर आने के बाद )
        
        5 cm below deltoid tuberosity it pierces (
        
        intermuscular septum to reach anterior compartment of arm ( भुजा के सामने कक्ष में आता हैं )
        
        descends down to cross lateral epicondyle of humerus ( पार्श्व स्थूलक को पार करके )
        
        terminates by dividing ( विभाजित होता हैं )
        
        superficial branch ( ऊपरी
        
        deep branch ( निचली )
  - Cubital fossa
    - superficial and deep branch continue in cubital fossa
  - Forearm
    - superficial ( sensory ) branch
      - passes along front of the radial side of forearm
      - at first lies
        
        slightly lateral to radial artery concealed beneath brachioradialis
      - in middle third of forearm
        
        lies behind same muscle
      - in lower forearm 7 cm above wrist
        
        passes beneath tendon of brachioradialis
        
        divides in to
        
        medial branch
        
        communicates
        
        above wrist
        
        with the dorsal branch of the lateral antebrachial cutaneous
        
        back of hand
        
        dorsal branch of the ulnar nerve
        
        then divides in to four digital nerves
        
        first supplies ulnar side of thumb ( अंगूठे का पिछला और मध्यवर्ती भाग )
        
        second radial side of index finger
        
        third - adjoining sides of index and middle fingers
        
        fourth -
        
        lateral branch
        
        supplies the radial (lateral) side of thumb
        
        ball of thumb
    - Deep branch ( motor ) or posterior interosseus nerve
      - winds to the back of forearm ( प्रभुजा के पीछे भाग में जाता है और )
        
        around lateral side of radius
        
        between two planes of fibers of supinator ( उत्तानन पेशी के दो स्तर के बीच )
        
        prolonged downwards to middle of forearm
        
        supplies motor muscles in posterior compartment
        
        extensor compartment
      - clinical
        
        wrist drop due to paralysis to posterior cord
        
        Radial dislocation
        
        injury to deep branch of radial nerve
        
        wrist drop

Injury
- Injury to the radial nerve at different levels causes different syndromes with varying motor and sensory deficits.
- AT THE AXILLA ( काँख में )
  - Common mechanisms of injury: Saturday night palsy, crutch palsy, lesions
  - Motor deficit:
    - Loss of extension of forearm, weakness of supination, and loss of extension of hand and fingers.
    - Presence of wrist drop, due to inability to extend the hand and fingers.
  - Sensory deficit: Loss of sensation[8] in lateral arm, posterior forearm, the radial half of dorsum of hand, and dorsal aspect of radial 3+1⁄2 digits, excluding their nail beds.
- AT MIDARM
  - Common mechanism of injury: Mid-shaft humeral fracture
  - Motor deficit:
    - Weakness of supination, and loss of extension of hand and fingers.
    - Presence of wrist drop, due to inability to extend the hand and fingers.
  - Sensory deficit: Loss of sensation in posterior forearm, the radial half of dorsum of hand, and dorsal aspect of radial 3+1⁄2 digits, excluding their nail beds.
- JUST BELOW ELBOW
  - Common mechanism of injury: Neck of radius fracture, elbow dislocation or fracture, tight cast, rheumatoid nodules, injections due to tennis elbow, injuring the deep branch of the radial nerve that pierces the radial head, causing posterior interosseous nerve syndrome
  - Motor deficit:
    - Weakness in extension of hand and loss of extension of fingers.
    - Presence of finger drop, and partial wrist drop, since the extensor carpi radialis longus and brachioradialis muscles are working.
  - Sensory deficit: None, as sensation is supplied by the superficial radial nerve
- WITHIN DISTAL FOREARM
  - Common mechanism of injury: Wartenberg's syndrome, (not to be confused with Wartenberg's sign), due to nerve entrapment beneath the tendinous insertion of brachioradialis, tight jewellery, and watch bands.
  - Motor deficit: None
  - Sensory deficit: Numbness and tingling in radial half of dorsum of hand, and dorsal aspect of radial 3+1⁄2 digits, excluding their nail beds.
  - In Wartenberg's syndrome, there is significant radial wrist pain, and close resemblance to symptoms in de Quervain's tenosynovitis. Finkelstein's test may be positive

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Radial Nerve

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