Written by Mavis Tham, Shamaine Soh and Yuna Zhuang, Principal Hand Occupational Therapists at Phoenix Rehab.Clinically reviewed by Nigel Chua, Principal Hand Occupational Therapist & Director, AHPC A1300362Z.Last reviewed 2 October 2026.
Radial nerve palsy means the wrist and fingers cannot lift. The hand hangs, the fingers will not straighten at the knuckles, and the thumb will not come out to the side. Grip feels weak, but the grip muscles are usually fine. They are just working from a wrist that has nothing holding it up.
That last point is the one worth understanding first, because it explains both why the hand feels so useless and why a splint helps so much. Your finger flexors pull best when the wrist is held slightly back. Let the wrist drop and the same muscles lose most of their power. So a hand with a radial nerve palsy often has near normal flexor strength and almost no usable grip, and putting the wrist back where it belongs gives a surprising amount of function back on the first day.
What it looks like
The pattern is specific. Wrist extension is gone or weak, so the hand drops. The knuckles will not straighten, though the fingers themselves can still bend and can often straighten at the smaller joints. Thumb extension is lost. There is usually a patch of numbness over the back of the hand between the thumb and index finger, though sensation is rarely the main complaint.
What is not affected is worth noting too. Bending the fingers and making a fist are driven by nerves that are not involved, which is why people are often told the hand looks worse than it tests.
Why it happened
The radial nerve wraps around the shaft of the upper arm bone, which puts it in two kinds of trouble. The first is a fracture of the humerus, where the nerve is bruised or stretched at the moment of injury or, less often, during the surgery that fixes it. The second is sustained compression, classically from falling asleep with the arm over the back of a chair or with someone lying on it. A tight cast or a tourniquet can do the same thing.
Which of those it was matters, because it changes the timeline more than any treatment does.
How long it takes to come back
A nerve that was compressed or bruised without the fibers being torn usually recovers over weeks to a few months, and often completely. A nerve where the fibers were disrupted has to regrow from the point of injury outwards, and it does that at roughly one millimeter a day, which from the middle of the upper arm to the wrist is a matter of months. Your doctor can work out the distance in your case and nerve conduction studies can tell you which category you are in.
This is the part where a therapist cannot help you and a doctor can. If you have a wrist drop and nobody has arranged nerve conduction studies, ask your GP or the surgeon who fixed the fracture. That test is what turns a guess into a timeline.
What the splint is for
Two different jobs, and they get confused. A static wrist splint holds the wrist up so the finger flexors can work. It gives you function today, which matters if you are trying to hold a cup, a phone or a steering wheel. A dynamic extension splint uses outriggers and rubber bands to lift the knuckles and thumb, so the fingers open passively and close under your own power. That gives you a working hand while the nerve recovers.
The second job is prevention. A hand that sits in a fist for three months develops stiffness on top of the palsy, and the stiffness does not go away when the nerve comes back. Keeping the joints moving through their full range every day, whether by splint or by hand, is the part of this that is entirely within your control.
What a hand therapist actually does
Makes the splint, and remakes it as the nerve recovers, because the splint that is right at week two is wrong at week ten. Keeps every joint in the hand at full passive range, which is done rather than advised. Tracks the return of muscle activity, so you know whether anything is happening. Teaches you the one handed workarounds that get you through the months in between. And when strength starts to arrive, loads it properly rather than waiting for it to feel normal.
Hand and wrist cases are managed by our hand therapy team, and the first appointment is an Assessment and Treatment, 45 minutes, $230 nett, no GST. Most of that 45 minutes is the splint and the range work, not the talking.
When it is not coming back
If the nerve conduction studies show no recovery after the time your surgeon expected, the conversation changes to tendon transfer, which is surgery that reroutes a working tendon to do the job of one that is no longer driven. That is a surgical decision and a surgical referral. What makes someone a good candidate for it is a hand with full passive range, which is another way of saying that the range work you did in the waiting months is what protects your options.
Where are you with this right now?
1. It is settling on its own
Many hand problems settle with a well fitted splint, changes to what provokes them, and tendon gliding. A tender scar and weak grip for a few weeks after surgery are usual. If it is easing week on week, and grip is improving month on month, it is behaving as expected. You do not need us for this, and we would rather say so.
2. It has stopped improving
You hand the jar to someone else. You button the shirt one-handed. You have stopped using that hand for anything that matters and barely noticed when it started.
The hand is the part of the body where stiffness sets in fastest, because a hand that hurts gets used less within days rather than weeks. That is the gap worth measuring, and it is not measured by how you feel on the day.
The Stalled Recovery Review is three appointments over three weeks with the same therapist, because what a joint does under load cannot be read in one visit. The first finds what is limiting it. The next two measure how it responds. $690, nett, no GST, which is three appointments at $230.
3. You have had surgery, or you have a date
Recovery after an operation has a shape, and knowing which stage you are in tells you whether you are on it. See the recovery programs, or hand therapy after surgery if you are not sure which applies to you.
All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
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