Wrist drop: Difference between revisions

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{{Wrist drop}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}


==Overview==
{{SK}} Radial nerve palsy
Wrist drop, also known as '''radial nerve palsy''', is a condition where a person can not extend their [[wrist]] and it hangs flaccidly. To demonstrate wrist drop, hold your arm out in front of you with your forearm parallel to the floor. With the back of your hand facing the ceiling (i.e. pronated), let your hand hang limply so that your fingers point downward. A person with wrist drop would be unable to move from this position to one in which the fingers are pointing up towards the ceiling.


==Anatomy of the forearm==
==[[Wrist drop overview|Overview]]==
==[[Wrist drop anatomy|Anatomy]]==


In anatomical parlance, the [[forearm]] is the part of the body which extends from the elbow to the wrist and is not to be confused with the arm which extends from the shoulder to the elbow.  The extensor muscles in the forearm are [[extensor carpi ulnaris]], [[extensor digiti minimi]], [[extensor digitorum]], [[extensor indicis]], [[extensor pollicis longus]], [[extensor pollicis brevis]], [[extensor carpi radialis brevis]], [[extensor carpi radialis longus]].  These extensor muscles are supplied by the [[radial nerve]].  Other muscles in the forearm also innervated by the radial nerve are [[brachioradialis]], [[supinator]] and [[abductor pollicis longus]].  Note that all these muscles are situated in the posterior half of the forearm (posterior when in the [[anatomical position]]).
==[[Wrist drop pathophysiology|Pathophysiology]]==


==Differential diagnosis of causes of wrist drop==  
==[[Wrist drop causes|Causes]]==


Wrist extension is achieved by [[muscle]]s in the [[forearm]] contracting, pulling on [[tendon]]s that attach distal to (beyond) the wrist. If the tendons, the muscles, or the [[nerve]]s supplying these muscles, are not working as they should be, wrist drop may occur.  The following situations may result in wrist drop:
==[[Wrist drop differential diagnosis|Differentiating Wrist Drop from other Diseases]]==


Stab wounds to the chest at or below the clavicle may result in wrist drop.  The radial nerve is the terminal branch of the posterior cord of the [[brachial plexus]].  A stab wound may damage the posterior cord and result in neurological deficeits including an inability to abduct the shoulder beyond 15 degrees, an inability to extend the forearm, reduced ability to supinate the hand, reduced ability to abduct the thumb and sensory loss to the posterior surface of the arm and hand.
==[[Wrist drop epidemiology and demographics|Epidemiology and Demographics]]==


The radial nerve can be damaged if the humerus (the bone of the arm) is broken, because it runs through the radial groove on the lateral border of this bone.
==[[Wrist drop risk factors|Risk Factors]]==


Wrist drop is also associated with [[lead poisoning]] because of the effect of [[lead]] on the radial nerve.<ref name="pmid16808730">{{cite journal |author=Dedeken P, Louw V, Vandooren AK, Geert V, Goossens W, Dubois B |title=Plumbism or lead intoxication mimicking an abdominal tumor |journal=Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine |volume=21 |issue=6 |pages=C1-3 |year=2006 |pmid=16808730 |doi=10.1111/j.1525-1497.2006.00328.x}}</ref>
==[[Wrist drop natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
Persistent injury to the nerve is also a common cause through either repetitive motion or by applying pressure externally along the route of the radial nerve as in the prolonged use of crutches or extended leaning on the elbows.


==Diagnosis==
==Diagnosis==
 
[[Wrist drop history and symptoms|History and Symptoms]] | [[Wrist drop physical examination|Physical Examination]] | [[Wrist drop laboratory findings|Laboratory Findings]] | [[Wrist drop x ray|X Ray]] | [[Wrist drop CT|CT]] | [[Wrist drop MRI|MRI]] | [[Wrist drop other diagnostic studies|Other Diagnostic Studies]]
The workup for wrist drop frequently includes nerve conduction velocity studies to isolate and confirm the radial nerve as the source of the problem.  Plain films can help identify bone spurs and fractures that may have injured the nerve.  Sometimes MRI imaging is required to differentiate subtle causes. 


==Treatment==
==Treatment==
[[Wrist drop medical therapy|Medical Therapy]] | [[Wrist drop surgery|Surgery]] | [[Wrist drop primary prevention|Primary Prevention]] | [[Wrist drop cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Wrist drop future or investigational therapies|Future or Investigational Therapies]]


Initial management includes splinting of the wrist for support along with [[occupational therapy|occupational]] or [[physical therapy]]. In some cases [[surgical]] removal of bone spurs or other anatomical defects that may be impinging on the nerve might be warranted.
== Case Studies ==
 
[[Wrist drop case study one|Caes #1]]
==See also==
==Related Chapters==
* [[Radial neuropathy]]
* [[Radial neuropathy]]
==References==
{{Reflist|2}}


{{Diseases of the musculoskeletal system and connective tissue}}
{{Diseases of the musculoskeletal system and connective tissue}}

Latest revision as of 21:16, 28 January 2013

For patient information, click here

Wrist drop
Radial Nerve Palsy: Note inability of patient to extend right wrist.
(Image courtesy of Charlie Goldberg, M.D.)

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X Ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and keywords: Radial nerve palsy

Overview

Anatomy

Pathophysiology

Causes

Differentiating Wrist Drop from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X Ray | CT | MRI | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Caes #1

Related Chapters

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