Physiotherapy management and therapeutic exercise in drop hand due to radial nerve palsy after orif of humeral fracture: A case report
DOI:
https://doi.org/10.54957/ijhs.v6i4.2360Keywords:
case report, drop hand, fraktur humerus, radial nerve palsy, hand splintAbstract
Background: Postoperative radial nerve palsy after Open Reduction Internal Fixation (ORIF) of a humeral shaft fracture may cause wrist drop, sensory disturbance, weakness of the wrist extensors, and limitations in upper-extremity activities. Physiotherapy is intended to reduce secondary impairments, maintain joint mobility, and support function during nerve recovery. Objective: This case report aimed to evaluate clinical changes following physiotherapy management in a patient with wrist drop due to postoperative radial nerve palsy after ORIF of a closed right humeral shaft fracture at PKU Muhammadiyah Bantul Hospital. Methods: This study used a case report design involving a 21-year-old male patient. Assessments were performed at T1, T2, and T3 and included pain using the Visual Analog Scale (VAS), range of motion using a goniometer, muscle strength using Manual Muscle Testing (MMT), sensory examination, and functional ability using the Wrist Hand Disability Index (WHDI). Interventions consisted of infrared therapy, Passive Range of Motion (PROM), Active Range of Motion (AROM), isometric exercise, sensory stimulation, wrist positioning, a hand splint used at home, and a home exercise program. Data were analyzed descriptively. Results: Pain decreased across the three treatment sessions. Recorded shoulder, elbow, and wrist range of motion improved, with the greatest gains observed at the shoulder and elbow. Shoulder flexion/abduction and elbow extension muscle strength increased from 3/5 to 4/5, whereas wrist extensor strength remained 2/5 and wrist drop persisted. WHDI scores decreased from 40 at T1 to 31 at T3, indicating functional improvement despite persistent disability. Conclusion: Multimodal physiotherapy over three visits was associated with reduced pain, improved recorded joint mobility, increased proximal muscle strength, and a lower WHDI score. However, motor recovery of the wrist extensors was not demonstrated, and longer follow-up is required.
References
Chiaramonte, R., Pavone, V., Testa, G., Pesce, I., Scaturro, D., Musumeci, G., Mauro, G. L., & Vecchio, M. (2023). The Role of Physical Exercise and Rehabilitative Implications in the Process of Nerve Repair in Peripheral Neuropathies : A Systematic Review.
DeCastro, A., Cyphers, G., & Sun, C. E. B. T.-S. (2026). Wrist Drop. StatPearls Publishing.
Glover, N. M., & Coffield, S. B. T.-S. (2023). Anatomy, Shoulder and Upper Limb, Radial Nerve. StatPearls Publishing.
Gomez, C., Perez, A., Breyer, J. M., & Vergara, P. (2025). Time to Recovery of Radial Nerve Palsy After Surgically Treated Humeral Shaft Fractures. Journal of Hand Surgery, 50(9), 1081–1087. https://doi.org/10.1016/j.jhsa.2024.11.024
Hegeman, E. M., Polmear, M., Scanaliato, J. P., Nesti, L., & Dunn, J. C. (2020). Incidence and Management of Radial Nerve Palsies in Humeral Shaft Fractures : A Systematic Review. 12(11), 4–13. https://doi.org/10.7759/cureus.11490
Hendrickx, L. A. M., Hilgersom, N. F. J., Alkaduhimi, H., Doornberg, J. N., & Bekerom, M. P. J. Van Den. (2021). Radial nerve palsy associated with closed humeral shaft fractures : a systematic review of 1758 patients. Archives of Orthopaedic and Trauma Surgery, 141(4), 561–568. https://doi.org/10.1007/s00402-020-03446-y
Investigators, H., Van Bergen, S. H., Van Lieshout, E. M. M., Verhofstad, M. H. J., Den Hartog, D., Beetz, I., Bolhuis, H. W., Bos, P. K., Bronkhorst, M. W. G. A., Bruijninckx, M. M. M., De Haan, J., Deenik, A. R., Den Hoed, P. T., Eversdijk, M. G., Goslings, J. C., Haverlag, R., Heetveld, M. J., Kerver, A. J. H., Kolkman, K. A., … Zuidema, W. P. (2023). Recovery and functional outcome after radial nerve palsy in adults with a humeral shaft fracture: a multicenter prospective case series. JSES International, 7(3), 516–522. https://doi.org/10.1016/j.jseint.2023.02.003
Lanfranchi, E., Vandelli, S., Boccolari, P., Donati, D., Platano, D., & Tedeschi, R. (2024). Efficacy and patient acceptability of 3 orthosis models for radial nerve palsy. Hand Surgery and Rehabilitation, 43(2), 101677. https://doi.org/https://doi.org/10.1016/j.hansur.2024.101677
Maugeri, G., D’Agata, V., Trovato, B., Roggio, F., Castorina, A., Vecchio, M., Di Rosa, M., & Musumeci, G. (2021). The role of exercise on peripheral nerve regeneration: from animal model to clinical application. Heliyon, 7(11). https://doi.org/10.1016/j.heliyon.2021.e08281
Mitchell, T. W., Mitchell, S. A., & Wu, C. (2022). Radial Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint. Current Reviews in Musculoskeletal Medicine, 15(6), 581–589. https://doi.org/10.1007/s12178-022-09805-z
Okata, D., Tokeisham, K., Okoye, P. C., & Mammen, A. V. (2026). Peripheral nerve injuries, regeneration and repair. Orthopaedics and Trauma, 40(4), 176–181. https://doi.org/https://doi.org/10.1016/j.mporth.2026.05.001
Phansopkar, P., Athawale, V., Birelliwar, A., Naqvi, W., & Kamble, S. (2020). Article Case report Post-operative rehabilitation in a traumatic rare radial nerve palsy managed with tendon transfers : a case report. 36(141).
Shi, S., Ou, X., & Du, X. (2024). Enhanced nerve function recovery in radial nerve palsy patients with humerus shaft fracture: a randomized study of low-frequency pulse electrical stimulation combined with exercise therapy. Frontiers in Neurology, Volume 15-2024.
Smolle, M. A., Bösmüller, S., Puchwein, P., Ornig, M., Leithner, A., & Seibert, F. (2022). Complications in humeral shaft fractures – non-union , iatrogenic radial nerve palsy , and postoperative infection : a systematic review and meta-analysis. 95–108.
Tsagkaris, C., Papazoglou, A. S., Eleftheriades, A., Tsakopoulos, S., Alexiou, A., Găman, M.-A., & Moysidis, D. V. (2022). Infrared Radiation in the Management of Musculoskeletal Conditions and Chronic Pain: A Systematic Review. In European Journal of Investigation in Health, Psychology and Education (Vol. 12, Issue 3, pp. 334–343). https://doi.org/10.3390/ejihpe12030024
Van Veldhuizen, J., Roerdink, W. H., Soesman, N. M. R., Deenik, A. R., Waleboer, M., Verleisdonk, E. J. M. M., Bos, P. K., Van der Heijden, F. H. W. M., Cnossen, J. D., Zuidema, W. P., Eversdijk, M. G., Notenboom, C. (Marije) A. W., Van Dijk, J. P., Punt, B. J., Den Hoed, P. T., Cheng, K., Bousema, J. E., Van Jonbergen, H.-P. W., Verhofstad, M. H. J., … Verwer, M. (2023). Functional and Clinical Outcomes After Plate Osteosynthesis Versus Intramedullary Nailing of a Humeral Shaft Fracture: The Results of the HUMMER Multicenter, Prospective Cohort Study. Journal of Bone and Joint Surgery, 105(14), 1101–1111. https://doi.org/10.2106/JBJS.22.00647
Wu, A.-M., Bisignano, C., James, S. L., Abady, G. G., Abedi, A., Abu-Gharbieh, E., Alhassan, R. K., Alipour, V., Arabloo, J., Asaad, M., Asmare, W. N., Awedew, A. F., Banach, M., Banerjee, S. K., Bijani, A., Birhanu, T. T. M., Bolla, S. R., Cámera, L. A., Chang, J.-C., … Vos, T. (2021). Global, regional, and national burden of bone fractures in 204 countries and territories, 1990&-2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet Healthy Longevity, 2(9), e580–e592. https://doi.org/10.1016/S2666-7568(21)00172-0
Yang, F., Cheng, Y., & Zhang, K. (2022). Adherence of unpublished case reports to the Case Report (CARE) guidelines: a retrospective cross-sectional analysis of 139 case report manuscripts initially submitted to AME medical journals. AME Medical Journal; Vol 7 (December 30, 2022): AME Medical Journal.
Yeh, K.-L., Liaw, C.-K., Wu, T.-Y., & Chen, C.-P. (2021). Radial nerve recovery following closed nailing of humeral shaft fractures without radial nerve exploration: A retrospective study . World Journal of Clinical Cases, 9(27), 8044–8050. https://doi.org/10.12998/wjcc.v9.i27.8044
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