Radial nerve palsy can be life-altering, affecting hand function, grip strength, and daily activities. But what if neurological dry needling could help restore movement and sensation? In this case study, I share how a patient with severe radial nerve damage progressed from minimal wrist and thumb function to full recovery—regaining strength, dexterity, and even returning to work and sports.

Watch the full breakdown in our Clinical Relevance video above, where I demonstrate key neural pathways, dry needling techniques, and clinical progressions in real time.

Case Overview: A Patient with Severe Radial Nerve Damage

A 35-year-old male patient came to me three months post-injury, presenting with significant left radial nerve palsy. His injury occurred after prolonged compression of the nerve while intoxicated, and his symptoms included:

 ✅ Severe weakness in the wrist and fingers, limiting extension
✅ Complete inability to move the thumb, affecting grip and dexterity
✅ Reduced sensation to light touch over the radial nerve pathway
✅ Functional loss of the left hand, interfering with work and daily tasks

Despite seeking multiple medical opinions and undergoing an EMG study showing severe denervation, the patient was only recommended wrist bracing with a tentative plan for tendon transfer surgery. With no rehabilitation plan offered, he sought out Integrative Dry Needling for an alternative approach.

Initial Dry Needling Treatment Approach

Given the patient’s aversion to needles, our first session focused on precise neurofunctional dry needling, using an in situ technique without manipulation for 10 minutes. Our comprehensive approach included:

🔸 Spinal Nerve Roots: C5 and C6 bilaterally to address nerve root contributions
🔸 Proximal Nerve Pathway: Axillary nerve emergent points to facilitate neuromuscular activation
🔸 Radial Nerve Entrapment Sites: Deep radial nerve, posterior interosseous nerve, and superficial radial nerve homeostatic points
🔸 Supporting Musculature: Targeted needling of the infraspinatus, triceps (between the heads), supinator, and lateral humerus regions

The patient reported deep, heavy aching throughout the treatment—a positive sign of neurogenic response. While pinprick sensation was present during assessment, light touch remained absent, confirming the need for continued neurological input.

Progress Over Six Dry Needling Sessions

Over a six-week treatment period (October 24th to December 5th), we implemented a progressive neurofunctional approach:

📊 Session 1-2 (6 days apart):

• Initial in situ needling without manipulation
• Significant improvements in wrist and finger extension within just six days
• Patient reported increased sensation and decreased heaviness
• Able to type for 3 minutes before fatigue onset

📊 Sessions 3-4:

• Continued with same needling points but added gentle manual stimulation
• Introduced low-frequency electrical stimulation (2 minutes per session) to optimize nerve activation
• Notable improvements in thumb movement initiation
• Patient now able to use hand for light functional tasks

📊 Sessions 5-6:

• Increased electrical stimulation duration with varied frequencies
• Complemented with targeted active movement during treatment
• Full restoration of thumb mobility (palmar abduction, radial abduction, circumduction)
• Complete wrist control with digital extension and full supination

By our final session, the patient had resumed work as a concrete contractor handling heavy tools, returned to recreational activities including skiing and surfing, and reported minimal fatigue even after demanding workdays.

The Neurological Mechanism of Recovery

Traditional rehabilitation approaches often overlook the complete neurogenic pathway in nerve injuries. Our dry needling protocol achieved remarkable results by addressing:

⚡ Neuroinflammation: Reducing inflammatory mediators along the entire radial nerve pathway
⚡ Neuromuscular Guarding: Normalizing protective tone that restricted active movement
⚡ Neural Conduction: Enhancing action potential transmission at key entrapment points
⚡ Motor Recruitment: Restoring normal firing patterns and muscle activation sequencing
⚡ Sensorimotor Integration: Improving proprioceptive feedback for coordinated movement

This multifaceted approach was critical for achieving rapid, functional improvements without surgical intervention.

Key Clinical Considerations

When implementing this approach, clinicians should consider:

🔍 Patient Selection: Best results occur within 3-6 months post-injury, though improvements are possible in chronic cases
🔍 Treatment Progression: Begin conservatively with in situ techniques before advancing to electrical stimulation
🔍 Contraindications: Use caution with anticoagulant medication, severe needle phobia, or active infection
🔍 Complementary Approaches: Pair with targeted active exercise, mirror therapy, and functional retraining
🔍 Home Program: Prescribe specific neuromuscular activities between sessions to reinforce gains

This case demonstrates that even severe radial nerve palsy with confirmed denervation can respond remarkably to skilled neurofunctional dry needling, potentially avoiding more invasive surgical interventions.

Key Takeaways for Clinicians

🔥 Radial nerve palsy requires active intervention beyond bracing and monitoring
🔥 Neurological dry needling effectively addresses both nerve and muscle components
🔥 Strategic targeting of neuro-trigger points optimizes nerve conduction and muscle activation
🔥 Progressive treatment protocols yield superior outcomes compared to static approaches
🔥 Full functional recovery is possible even in cases initially recommended for surgery

This case highlights the transformative potential of dry needling in neurological rehabilitation, reinforcing the need for advanced assessment and treatment of nerve dysfunction in complex upper extremity cases.

💬 Have you treated radial nerve palsy with dry needling? Share your experiences in the comments below!

📢 For more in-depth clinical insights on dry needling for nerve injuries, subscribe to our Clinical Relevance YouTube series from Integrative Dry Needling and access our comprehensive training resources.

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