1629 - A Swing Too Far: Monitoring the Recovery of a Radial Nerve Injury after a Pickleball Injury

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SC

Sovanndy B. Cheav, DO

Resident
Northwestern Marianjoy Rehabilitation Hospital
Lombard, Illinois, United States

Co-Author(s)

BS

Bharathi Swaminathan, MD

Principal Investigator
Chicago Medical School at Rosalind Franklin University of Medicine & Science; FHCC-Lovell VA
North Chicago, Illinois, United States

Submitter(s)

SC

Sovanndy B. Cheav, DO

Captain James A. Lovell Federal Health Care Center
Lombard, Illinois, United States

Case Diagnosis: A 72-year-old male presented to our clinic for ongoing left hand/wrist weakness and numbness. Symptoms began 10 months prior when he reached out to hit a ball and fell forward catching his arm on a pickleball net. He was diagnosed with a humeral shaft fracture and underwent surgical fixation. Electrodiagnostic studies (EDX) confirmed a left radial neuropathy at the spiral groove. EDX was repeated at seven and ten months to monitor for reinnervation.

Case Description: EDX studies were conducted at three, seven-, and ten-months post injury and muscle strength was 1/5, 3/5, and 4/5, respectively in left wrist extension. Initial EMG showed spontaneous activity and decreased recruitment in the left brachioradialis (BR), extensor digitorum communis (EDC) and extensor indicis proprius (EIP). Sensory nerve conduction (SNC) of the left radial nerve was unobtainable. Motor nerve conduction (MNC) showed prolonged latency and decreased amplitude. Following EMGs showed decreased spontaneous activity and polyphasic waves in the BR, triceps, EIP, and EDC. Management was conservative with occupational therapy and bracing.

Discussions: Humeral shaft fractures are the leading cause of radial neuropathy in the arm and often highly susceptible to injury in the distal 1/3 of the humerus due to its p</span>osition overlying the periosteum. EDX studies can help differentiate radial, median, or ulnar neuropathies, as well as posterior p</span>lexopathy. In this case, EDX was used to help with prognostication and monitoring for reinnervation.

Conclusions: Initial management of radial neuropathy includes bracing along with physical and/or occupational therapy. If there is no improvement, surgical referral should be considered. This patient showed improvement in each successive visit on exam. EDX showed evidence of reinnervation as well. This case study provides an example of radial neuropathy secondary to a humeral fracture where EDX studies played a significant role in diagnosing and guiding management.