What a Pain! Injury to the Superficial Branch of the Radial Nerve
As a physical therapist (PT) or occupational therapist (OT), how can you help a patient who is experiencing severe pain on the dorsal aspect of their hand? Recovery from this painful condition may take weeks or months, and some patients even experience lifelong symptoms.1 Clinicians might encounter patients who have sought out pain relief from a variety of healthcare providers, with unsuccessful results. In this article, we’ll take a look at tools you can use to help patients manage this condition.
What Causes Pain on the Dorsal Aspect of the Hand?
The superficial branch of the radial nerve (SBRN) supplies sensation to the radial dorsal skin of the forearm and hand (see Figure 1). Injury to the superficial branch of the radial nerve is known to cause persistent neuropathic pain in this part of the hand.
Injuries to the superficial branch of the radial nerve can occur with:
- Trauma
- Surgery to the radial side of the hand
- Hand osteoarthritis
- Wearing a bracelet that is too tight
- Internal compression from brachioradialis or a lipoma
- Intravenous (IV) catheter
Figure 1: Typical Area of Pain Involvement Due to Superficial Branch of the Radial Nerve Injury
Two Key Strategies for Managing Pain from an Irritated Superficial Branch of the Radial Nerve
1. Using a TENS Unit
Transcutaneous electrical nerve stimulation (TENS) has been shown to produce analgesic effects through neurobiological mechanisms affecting peripheral nervous systems.2 TENS, set to comfortable, perceptible tingling, is one tool clinicians can use to help patients manage this troublesome pain.
In my experience, using the “Burst” setting and placing the electrodes proximal and distal to the painful area (see Figure 2) has been effective in decreasing pain to the irritated superficial branch of the radial nerve. Patients should wear the TENS unit 2-4 times a day, especially before bedtime to help with sleeping, but optimal frequency and duration of the TENS application varies in research studies.
Figure 2: Recommended TENS Electrode Placement
2. Adding Neoprene Padding
Another coping mechanism for individuals with pain at the superficial branch of the radial nerve is adding neoprene padding to the painful area (see Figure 3). This can help protect the area from accidental trauma and from bumping it during daily activities.
Figure 3: Neoprene Padding
Patients can also use a neoprene thumb orthosis with foam (see Figure 4) or silicone padding over the specific area with the nerve irritation.
Figure 4: Neoprene Thumb Orthosis with Foam
Watch for Improvement
In all cases, clinicians should monitor the patient and refer them to a hand surgeon if improvement doesn’t occur with these conservative measures. In some cases, surgeons can use repeated local anesthetic blocks, but in other cases this condition can result in a painful neuroma that requires surgical intervention.
References
- Boeson, M. B., Hranchook, A., & Stoller, J. (2000). Peripheral nerve injury from intravenous cannulation: a case report. AANA Journal, 68(1), 53–57.
- Sluka, K. A., Walsh, D. (2003) Transcutaneous electrical nerve stimulation: Basic science mechanisms and clinical effectiveness. Journal of Pain;4(3):109–21.
