Introduction: The radial nerve is the main extensor of the upper extremity and its injury leads to hand drop and inability to put a hand in a functional position, which produces disability in patients every day and work activities with big socioeconomic problems.

Aim: To evaluate functional outcome and quality of life after radial nerve injury surgical treatment. Cases with bad recovery were further analyzed, in order to evaluate the diagnostic and therapeutic protocol and to improve final outcome.

Material and methods: Our study included 140 patients surgically treated due to radial nerve injury during 20 years period. Muscle strength was evaluated using the “British Medical Research Council“ scale (MRC scale), while the level of motor recovery was classified using a modified scale of Highet and Holmes. Extension of the wrist, extension of the fingers and thumb, and thumb abduction were evaluated. The quality of life study was evaluated with the DASH (The Disabilities of the Arm, Shoulder and Hand”) and PNSQoL (“Peripheral Nerve Surgery Quality of Life”) questionnaire.

Results: Out of 140 patients, more than 2/3 were males and the mean population age was 38. The most common mechanism of nerve injury was fracture-related contusion. The majority of the patients were treated by neurolysis (68%) and sural nerve grafting (26%), while only a few were treated by direct suture or nerve transfer. Useful motor recovery was achieved in 91.4% of the analyzed patients, as well as in 96% of the cases with neurolysis, 78% of the cases with sural nerve grafting, and all cases with direct suture and nerve transfer. Surgical treatment in the first 6 months since the injury, lowenergy trauma, lesions with preserved continuity and lower graft length were associated with better motor recovery. Mean DASH and PNSQoL scores were 18.2 and 66.2, respectively.

Conclusion: Functional recovery after surgical treatment of the radial nerve palsy, as well as the quality of life and patient satisfaction were excellent. High-energy trauma is more commonly related to nerve continuity disruption and requires closer evaluation and earlier surgical treatment. Late patients referral and the need for long grafts were associated with the poorer recovery and the need for nerve and tendon transfer.

Keywords: radial nerve injury, surgical treatment, recovery