Electrophysiological localization and prognostic indicators in radial neuropathy presenting as wrist drop: a three-year retrospective observational study

Abstract

Background and Objective:
Radial neuropathy is a common cause of wrist drop, and accurate lesion localization is essential for appropriate
management and prognostication. The objective of this study was to analyze electrophysiological localization patterns of radial nerve lesions presenting as wrist drop and to assess whether earlier referral for electrophysiological evaluation was associated with recovery outcomes.
Methods:
This retrospective observational study was conducted at Lady Reading Hospital Peshawar, a tertiary care setting, over a three-year period (January 2022–December 2024). Adult patients with wrist drop and electrophysiological confirmed radial neuropathy were included. Nerve conduction studies and needle electromyography were used to classify lesions as high radial nerve palsy, posterior interosseous nerve (PIN) syndrome, or radial tunnel syndrome. Functional recovery at ≥3 months was categorized as complete, partial, or none. Outcomes were compared between early (≤4 weeks) and delayed (>4 weeks) electrophysiological evaluation. Data was analyze using SPSS version 25.0.

Results:
Fifty-four patients were analyzed (mean age 42.3 ± 15.2 years; 70.4% male). High radial nerve palsy was the most common lesion (61.1%), followed by PIN syndrome (29.6%) and radial tunnel syndrome (9.3%). Compression was the leading etiology. Complete recovery was significantly more frequent in patients undergoing early electrophysiological evaluation compared with delayed assessment (76.0% vs. 44.8%; p = 0.03).
Conclusion:
Early EMG testing itself does not directly improve nerve recovery. Instead, earlier electrophysiological referral may facilitate timely diagnosis and management, which could contribute to improved functional outcomes.