8614 - The musculospiral nerve (radial nerve)-Neuritis

DBQ: Link to Index of DBQ/Exams by Disability for DC 8614 

Definition

Neuritis refers to an inflammation of a nerve with pain and tenderness, anesthesia and paresthesia, paralysis, wasting, and disappearance of the reflexes. The radial nerve, predominantly a motor nerve. (See Diagnostic Code: 8611 Middle radicular group-Neuritis). This nerve innervates the main extensors of the forearm, wrist, and fingers.

Etiology

The middle third of the arm is the most common site of radial nerve injury. In some cases, the cause of neuritis may be unknown. Identified causes of the condition include: lacerations; blunt trauma; gunshot wounds; hemorrhage into a nerve; fractures of the humerus; dislocation of the radius; degenerative bone changes; compression of the nerve from crutches, watchbands or handcuffs; entrapment; prolonged elbow extension; tumors; exposure to cold or radiation; viruses; inflammatory conditions; systemic malignancy; leprosy; metabolic diseases such as diabetes mellitus or alcoholism; collagen blood disorders; toxic agents; certain medications; nutritional deficiencies; and genetics.

Signs & Symptoms

Signs and symptoms may vary depending on the form of neuritis and the location of the lesion along the nerve. Manifestations of the condition may include: neuralgia; hyperesthesia; paresthesia; dysesthesia; hypoesthesia; demyelination; triceps paralysis; loss of triceps reflex; impaired elbow extension; elbow pain; weakness or paralysis of extension of the wrist, thumb, and fingers; weakness of hand adduction; wrist drop; loss of grip; and loss of supination in forearm extension. There may be slight sensory loss localized to small areas of the hand, thumb, index and middle fingers, as well as pain in the affected areas. Depending on the involvement of neighboring nerves, there may be other signs and symptoms.

Tests

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

Treatment

Treatments may include management of the underlying disorder. In some cases, there may be no specific treatment. Measures of treatment may include: wrist splints; passive range of motion (ROM) exercises; anti-inflammatory or pain medications; transcutaneous electrical nerve stimulation (TENS); antibiotics; and vitamin therapy. In some cases, surgery may be needed when recovery is poor or weakness progresses.

Residuals

Regeneration of the nerve may depend on the degree and site of injury. The closer the injury is to the central nervous system (CNS), regeneration of a severely injured nerve is less likely to occur. In compression injury, complete recovery may take weeks depending on the length and severity of compression. Recovery from weakness may take several months. Painful paresthesias or dysesthesias of the wrist may develop. There may be a need for long-term pain management. There also may be alteration of employment and daily activities requiring counseling intervention.

Special Considerations

  • 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).

Notes

  • Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. See nerve involved for diagnostic code number and rating. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis.  38 CFR 4.123 Neuritis, cranial or peripheral.

  • With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves] 38 CFR 4.124a Schedule of ratings—neurological conditions and convulsive disorders.