Paralysis refers to a temporary or permanent loss or impairment of motor or sensory function in a part. The middle radicular group refers to the VIIth cervical root which consists of motor and sensory pathways. This middle group is one of three trunks forming the brachial plexus.

Paralysis of these nerves may be caused by damage to the nerve fibers, cell body, or myelin sheath. Causes of the damage may include: trauma; penetrating missile injury; shoulder injury; overextension of a joint; brachial neuritis; carrying heavy objects supported at the shoulder; and iatrogenic injection injuries. Other etiologic factors may include: metabolic injury; infection; and compression of the nerve from degenerative bone changes, nerve entrapment, fractures, inflammation, or tumors.

Signs and symptoms simulate those of the radial nerve and may include: triceps weakness or paralysis; muscle atrophy; inability to extend the elbow; elbow pain; and inability to extend the wrist, fingers and thumb. In addition, other evidence may include: wrist drop; loss of triceps reflex; weakness of adduction of the hand; and loss of supination of the forearm in extension. There may also be slight sensory loss to a confined area of the forearm, hand, thumb or the index and middle fingers as well as pain in the affected areas.

Diagnostic measures may include: a complete history; physical and neurological examinations; motor, sensory, reflex, strength and resistance tests; blood studies; spinal tap; evoked responses; electromyography (EMG); x-ray; computed tomography (CT) scan; and magnetic resonance imaging (MRI).

Treatments may include management of the underlying disorder. Additional measures may include: splints; passive range of motion (ROM) exercises; anti-inflammatory or pain medications; transcutaneous electrical nerve stimulation (TENS); or, in some cases, surgery may be needed.

Regeneration may depend on the degree of axonal injury and site of injury. The closer the injury is to the central nervous system (CNS), regeneration of a severely damaged nerve is less likely to occur. Recovery may range from return to complete function to permanent dysfunction. In compression injury, complete recovery may take weeks depending on the length and severity of compression. Supination may be possible via the action of the biceps. In the presence of triceps paralysis, forearm extension may be achieved via gravity. There may be injuries to other distal peripheral nerves. Intensive rehabilitation may be delayed for certain injuries. Alteration of employment and daily activities may require counseling intervention.

• If the Veteran is a former prisoner of war and was interned or detained for not less than 30 days, this disease shall be service connected if manifest to a degree of disability of 10% or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR §3.309(c) Disease subject to presumptive service connection].

• If the Veteran was exposed to an herbicide agent during active military, naval, or air service, this disease shall be service-connected if the requirements of 38 CFR 3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 CFR 3.309(e). Disease subject to presumptive service connection

• Consider potential entitlement to special monthly compensation for loss of use of hand or foot when assigning the higher evaluations under particular Diagnostic Codes (e.g., Diagnostic Code 8510 through 8515, 8520, and 8521).

• The term “incomplete paralysis,” with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor.