COMPREHENSIVE APPROACH TO PHYSICAL THERAPY FOR SERVICE MEMBERS WITH COMBAT-RELATED RADIAL NERVE INJURIES ASSOCIATED WITH HUMERAL FRACTURES
DOI:
https://doi.org/10.31891/pcs.2026.1.13Keywords:
military personnel, combat injury, radial nerve, standardized tests, electroneuromyography, physical therapyAbstract
Combat-related peripheral nerve injuries, particularly of the radial nerve, are a widespread consequence of modern mine-blast and shrapnel trauma, leading to prolonged disability and high rates of functional impairment among service members. The clinical management of these cases is significantly complicated when neuropathy develops secondary to gunshot humeral fractures, which triggers extensive scarring, persistent perineural edema, and secondary nerve trunk ischemia. Despite substantial advancements in military medicine, optimizing physical therapy protocols to accelerate axonal reinnervation and restore hand functional capacity in polystructural injuries remains a highly relevant issue in modern rehabilitation.
The aim of the study was to justify and evaluate the effectiveness of a comprehensive physical therapy model for service members with traumatic radial nerve injuries, aimed at preventing secondary complications and achieving optimal functional recovery.
The study involved 28 service members diagnosed with traumatic radial neuropathy following shrapnel wounds and humeral osteosynthesis. The intervention group implemented a program including passive and active neuromobilization, sensory training, and functional electrical stimulation based on the biofeedback principle. The control group received standard range-of-motion exercises and passive electrical stimulation. Outcome measures included the Visual Analogue Scale for pain, manual muscle testing, the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) index, and electroneuromyography (ENMG) parameters. Reassessment after 3 months revealed a statistically significant advantage of the comprehensive program in the intervention group across all parameters (p < 0.05). A significant improvement in hand function according to QuickDASH and higher rates of nerve conduction recovery were established. Neurodynamic techniques were found to promote remyelination and reduce neuropathic pain, while active stimulation accelerated the reinnervation of the wrist extensor muscles. The results confirm the pathogenetic validity of the proposed approach and open prospects for its implementation into the rehabilitation system for military personnel at various stages of recovery.
References
Harrington C. J., Dearden M. E., McGlone P. et al. (2025).The Scope and Distribution of Upper Extremity Nerve Injuries Associated With Combat-Related Extremity Limb Salvage. Journal of Hand Surgery, 3, 384.e1–384.e5. https://doi.org/10.1016/j.jhsa.2023.09.008
Jung C., Yun J. H., Kim E. J., Park J., Yeom J., Kim K. E. (2024). Traumatic peripheral nerve injuries in young Korean soldiers: a recent 10-year retrospective study. Journal Trauma Inj, 37(3), 192–200. https://doi.org/10.20408/jti.2024.0001
Strafun S. S., Borzykh N. O., Haiko O. H., Borzykh O. V., Haiovych V. V., Tsymbaliuk Ya. V. (2018). Priorytetni napriamy khirurhichnoho likuvannia poranenykh z ushkodzhenniam peryferychnykh nerviv verkhnoi kintsivky pry polistrukturnykh travmakh [Priority areas of surgical treatment of wounded with damage to the peripheral nerves of the upper limb in polystructural injuries]. Travma, 3, 75-80. https://doi.org/10.22141/1608-1706.3.19.2018.136410 [in Ukrainian].
Dunn J. C., Eckhoff M. D., Nicholson T. C. et al. (2021). Combat-Sustained Peripheral Nerve Injuries in the United States Military. Journal of Hand Surgery American, 46(2), 1–8. https://doi.org/10.1016/j.jhsa.2020.08.004
Eckhoff M. D., Craft M. R., Nicholson T. C., Nesti L. J., Dunn J. C. (2021). Lower Extremity Combat Sustained Peripheral Nerve Injury in US Military Personnel. Plast Reconstr Surg Glob Open, 9(3), e3447. https://doi.org/10.1097/GOX.0000000000003447
Loboiko O. I. (2024). Osoblyvosti travmatychnykh ushkodzhen peryferychnykh nerviv u viiskovosluzhbovtsiv, yaki otrymaly vohnepalni poranennia kintsivok [Features of traumatic injuries of peripheral nerves in servicemen who received gunshot wounds to the extremities]. Zbirnyk naukovykh prats Naukovo-praktychnoi konferentsii «Nevrolohichni aspekty naslidkiv ushkodzhennia opornorukhovoi systemy pry boiovii travmi» (19 veresnia 2024 r., Kharkiv, Ukraina). Kharkiv, 14-17. URL: https://archive.sytenko.org.ua/communities/810b89e3-e875-4e9d-ac71-7b86ead10fa7 [in Ukrainian].
Akhavan-Sigari R., Mielke D., Farhadi A., Rohde V. (2018). Study of Radial Nerve Injury Caused By Gunshot Wounds and Explosive Injuries among Iraqi Soldiers. Open Access Macedonian Journal of Medical Sciences, 6(9), 1622–1626. https://doi.org/10.3889/oamjms.2018.346
Birch R., Misra P., Stewart M. P. et al. (2012). Nerve injuries sustained during warfare: part I – Epidemiology. Journal of Bone & Joint Surgery, 4, 523–528. https://doi.org/10.1302/0301-620X.94B4.28483
Howard I. M., Sedarsky K., Gallagher M., Miller M., Puffer R. C. (2025). Combat-related peripheral nerve injuries. Muscle Nerve, 71(5), 768–781. https://doi.org/10.1002/mus.28168
Wade S. M., Nesti L. J., Cook G. A. et al. (2020). Managing Complex Peripheral Nerve Injuries Within the Military Health System: A Multidisciplinary Approach to Treatment, Education, and Research at Walter Reed National Military Medical Center. Military Medicine, 185(5-6), 825–830. https://doi.org/10.1093/milmed/usz415
Robinson L. R. (2022). Traumatic injury to peripheral nerves. Muscle Nerve, 66(6), 661–670. https://doi.org/10.1002/mus.27706
Carey-Ewend A. G., Goldfarb J. H., Randall Z. D., Brogan D. M., Dy C. J. (2025). The Current State of Outcome Measurements After Peripheral Nerve Injury: A Systematic Review. Journal of Hand Surgery Global Online, 7(2), 192–195. https://doi.org/10.1016/j.jhsg.2024.12.001
Dy C. J., Antes A. L., Baltzer H. L. et al. (2025). COMET Nerve Study Group. Development of a Core Outcomes Set for Peripheral Nerve Injury. Journal of Hand Surgery Global Online, 7(4), 100724. https://doi.org/10.1016/j.jhsg.2025.02.014
Fader L., Nyland J., Li H., Pyle B., Yoshida K. (2022). Radial nerve palsy following humeral shaft fracture: a theoretical PNF rehabilitation approach for tendon and nerve transfers. Physiother Theory Pract, 38(13), 2284-2294. https://doi.org/10.1080/09593985.2021.1938310
Ni L., Yao Z., Zhao Y. et al. (2023). Electrical stimulation therapy for peripheral nerve injury. Front Neurol, 2, 1081458. https://doi.org/10.3389/fneur.2023.1081458
Shi S., Ou X., Du X. (2024). A prospective observational study comparing outcomes application of low-frequency pulse electrical combined with target-oriented rehabilitation therapy in postoperative nerve function rehabilitation of patients with distal humeral fracture and radial nerve injury. Front Neurol, 4, 1370313. https://doi.org/10.3389/fneur.2024.1370313
Basson A., Olivier B., Ellis R., Coppieters M., Stewart A., Mudzi W. (2017). The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis. Journal Orthop Sports Phys Ther, 9, 593–615. https://doi.org/10.2519/jospt.2017.7117
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ірина КАЛЬОНОВА, Олена БЕССАРАБОВА, Надія БОГДАНОВСЬКА
This work is licensed under a Creative Commons Attribution 4.0 International License.
