480 - Unlocking Recovery: The Power of Integrated Diagnostics and Multidisciplinary Care in Traumatic Radial and Axillary Neuropathy

Case Diagnosis: Severe right radial and axillary neuropathy after blunt impact trauma to right elbow

Case Description: A 66-year-old right-hand-dominant female with chronic axial and radicular neck pain presented with right arm pain, numbness and profound weakness after accidentally striking her elbow and proximal arm two months prior. Examination notable for limited active right shoulder abduction, a positive drop arm test, significant weakness with wrist and finger extension as well dorsal hand hypoesthesia. These findings raised concern for multiple mononeuropathies versus cervical radiculopathy prompting electrodiagnostic studies which revealed a right radial neuropathy at the upper arm at or distal to the spiral groove with complete axonal loss, along with partial axonal loss in the right axillary nerve. Diagnostic ultrasound confirmed fascicular disruption of the radial nerve at the spiral groove status post radial nerve hydrodissection leading to significant pain improvement, though weakness persisted.

Discussions: Radial nerve injuries, particularly after trauma, exhibit distinct clinical patterns depending on the site and extent of the damage. The recovery process is influenced by the severity and duration of compression. In the case of our patient who experienced a blunt trauma to her elbow, leading to severe deficits, the use of neuromuscular ultrasound (NMUS), alongside electrodiagnostic studies, is crucial. NMUS offers dynamic, structural insights that enhance diagnostic accuracy. When conservative treatments fail to restore function, it's important to consider a multidisciplinary approach involving orthopedic surgery, to discuss options such as nerve or tendon transfers, which may significantly improve outcomes given seven months of persistent wrist drop.

Conclusions: This case underscores the importance of combining electrodiagnostic studies with NMUS in accurately diagnosing the extent of nerve damage and emphasizes the value of a multidisciplinary approach. Timely, coordinated care optimizes outcomes and helps guide surgical decision-making in complex cases of peripheral nerve injury.