Splinting as a way to treat Radial Nerve Palsy

Splinting for Radial Nerve Palsy (wrist drop)

I recently saw a patient in the hospital with radial nerve palsy, and was surprised that most doctors and therapists don’t know the best splinting options for this diagnosis.  

Radial nerve palsy results in wrist drop or the inability to extend the wrist and digits.  The digits and wrist will still flex, because the median and ulnar nerve are still intact, but without wrist extension the hand becomes non-functional. 

This inability to use 50% of the hand and wrist makes splinting a challenge. 

The best splint for radial nerve palsy is a dynamic extension splint, because it not only restores function, but reduces wrist contractures.

You can also use other splints as a temporary option, but they’re not as functional.

In this article, I’ll discuss radial nerve palsy in further detail, splint options, where to purchase, and how to make your own. 

Let’s get into it!

What is Radial Nerve Palsy?

Radial nerve palsy, also known as Saturday night palsy, is a common diagnosis associated with wrist drop.  In most cases, it’s caused after a fall when the person is lying on the outstretched arm for a prolonged period of time.  

Hence the name, Saturday night palsy. 

Have you ever slept on your arm above your head and woke up with numbness and tingling?  That prolonged pressure on the axilla nerve can cause weakness or permanent damage to the radial nerve.  

Damage to the radial nerve results in loss of wrist and digit extension.

Radial nerve palsy can also be caused by 

  • Humeral fracture
  • Car accident
  • Fall on outstretched arm
  • Surgery of the upper extremity
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The best way to treat radial nerve palsy is to first place a patient in a functional splint to restore function to the digits. With a dynamic splint, the hands will be able to be used for normal functional activities (dressing, feeding, grooming).

Performing these activities in combination with other exercises can help regain strength and range of motion to the injured hand. However, it may take up to 3 or 4 months before extension of the wrist and digits return.

Splinting for Radial Nerve Palsy

The most important consideration for splinting with radial nerve palsy is minimalizing contractures and maintaining function.

That’s why the dynamic extension splint is the perfect choice.  It keeps the wrist in neutral (slightly extended) and allows the fingers to move freely.

With the dynamic extension splint, the affected extremity can continue to be used for functional tasks such as grasp and release.  

Other options

Here are a list of other splints that can be used as a temporary solution.

  1. Wrist cockup
  2. Radial nerve splint
  3. Resting hand splint

If you’re unable to use a dynamic extension splint, you can use a wrist cockup or resting hand splint to reduce contractures.

A wrist cockup is your next best choice, because the patient will still be able to maintain a tenodesis grasp.

You’re second best option is to use a radial nerve splint. You would think this would be the best option, but it actually inhibits function. That’s why I prefer the dynamic extension splint or wrist cockup.

The last splint option is the resting hand splint. I would only recommend this splint if you’re trying to minimize joint contractures from extreme flexion.

Resting hand splints should be removed frequently for skin checks and passive range of motion exercises.  

The best splint for radial nerve palsy

The best prefabricated splint for wrist drop is this dynamic extension splint.

Don’t be fooled by some of the splints online that are marketed as dynamic extension splints.  Most dynamic extension splints online are static splints and do not allow digital motion.

These static splints do not have moving parts and are not functional.  See image below.

You’ll know if it’s a dynamic extension splint, because it will have moving parts, such as springs or pulleys.  

How to make a custom radial nerve palsy splint?

Splinting for radial nerve palsy is a bit technical and more expensive than buying one.

To read all about how to fabricate a dynamic extension splint for radial nerve palsy read my other post here.  

Here are some materials you will need.

  • Thermoplastic
  • Splint pan
  • Stockinette 
  • Industrial grade scissors
  • Phoenix outrigger kit
  • Thermoplastic glue
  • Pulley Slings
  • Rubber bands (Various sizes)
  • Yellow splint pencil
  • Cold spray

If you don’t have access to these materials consider purchasing a prefabricated splint as shown above.

Check out this unique video on splinting for radial nerve palsy.

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