Wrist drop: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 7: Line 7:
   Width          =  200|
   Width          =  200|
}}
}}
{{SI}}
{{Wrist drop}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}



Revision as of 19:53, 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.)

Wrist Drop Microchapters

Home

Patient Information

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

Case #1

Wrist drop On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Wrist drop

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Wrist drop

CDC on Wrist drop

Wrist drop in the news

Blogs on Wrist drop

Directions to Hospitals Treating Wrist drop

Risk calculators and risk factors for Wrist drop

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

Overview

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

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).

Differential diagnosis of causes of wrist drop

Wrist extension is achieved by muscles in the forearm contracting, pulling on tendons that attach distal to (beyond) the wrist. If the tendons, the muscles, or the nerves supplying these muscles, are not working as they should be, wrist drop may occur. The following situations may result in wrist drop:

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.

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 is also associated with lead poisoning because of the effect of lead on the radial nerve.[1]

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

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

Initial management includes splinting of the wrist for support along with 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.

See also

References

  1. Dedeken P, Louw V, Vandooren AK, Geert V, Goossens W, Dubois B (2006). "Plumbism or lead intoxication mimicking an abdominal tumor". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine. 21 (6): C1–3. doi:10.1111/j.1525-1497.2006.00328.x. PMID 16808730.

Template:Diseases of the musculoskeletal system and connective tissue


Template:WikiDoc Sources