Q: I am a 37 years old man who met with a road accident 4 months back leading to right humerus shaft fracture with radial nerve palsy but the nerve was intact. After 2 days, I underwent surgery with dynamic compression plate (DCP) under brachial block after immediate first-aid. Now I am able to lift four fingers of the hand vertically except my thumb. I am doing mild physiotherapy like closing and opening of five fingers continuously for few minutes, bicep exercises with free hand (without dumbbell). I feel no problem in closing and opening my fingers. But when doing bicep exercises, in closed condition, five fingers do not touch the shoulders and leave a gap of 5 inches. In an opening condition the forearm is not coming straight (slight semi-circle) and the shoulder-arm pouch is still there. How much time will it take for the forearm to become straight? Regarding the thumb, I am unable to lift the thumb vertically up. After doing exercises for 5-10 minutes, my thumb becomes tight and there is slight numbness and after a few minutes it becomes free from tightness and numbness. How can my thumb problem be corrected?

A:The radial nerve controls elbow, wrist, finger and thumb extension but the most obvious sign of radial nerve injury is 'wrist drop'. Extension of the thumb is done by a group of muscles, which is innervated by posterior interosseous nerve (branch of radial nerve). In radial nerve injuries this nerve recovers the last and that is the reason you are having difficulty in thumb extension. I think within the next 8-10 weeks you should start seeing recovery of this group of muscles of the thumb. Till that time you should continue to do physical therapy of the wrist and thumb to keep the joints supple. Regarding the elbow, I think you are suffering from posttraumatic stiffness. I would advise you to get rid of the elbow pouch, as this will only increase the stiffness. You should see a physical therapist who can work on improving the range of motion in your elbow. It might take several weeks before you can fully straighten your elbow.