Wrist drop is a medical condition in which the

wrist In human anatomy, the wrist is variously defined as (1) the Carpal bones, carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; "The wrist contains eight bones, roughly aligned in two rows, known ...

and the

fingers A finger is a limb of the body and a type of digit, an organ of manipulation and sensation found in the hands of most of the Tetrapods, so also with humans and other primates. Most land vertebrates have five fingers (Pentadactyly). Chambers 1 ...

cannot extend at the

metacarpophalangeal joint The metacarpophalangeal joints (MCP) are situated between the metacarpal bones and the proximal phalanges of the fingers. These joints are of the condyloid kind, formed by the reception of the rounded heads of the metacarpal bones into shallow cav ...

s. The wrist remains partially flexed due to an opposing action of flexor

muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...

s of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.

Forearm anatomy

The

forearm The forearm is the region of the upper limb between the elbow and the wrist. The term forearm is used in anatomy to distinguish it from the arm, a word which is most often used to describe the entire appendage of the upper limb, but which in anat ...

is the part of the body that 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 the

extensor carpi ulnaris In human anatomy, the extensor carpi ulnaris is a skeletal muscle located on the ulnar side of the forearm. The extensor carpi ulnaris acts to extend and adduct at the carpus/wrist from anatomical position. Being an extensor muscle, extensor carp ...

extensor digiti minimi The extensor digiti minimi (extensor digiti quinti proprius) is a slender muscle of the forearm, placed on the ulnar side of the extensor digitorum communis, with which it is generally connected. It arises from the common extensor tendon by a thi ...

extensor digitorum The extensor digitorum muscle (also known as extensor digitorum communis) is a muscle of the posterior forearm present in humans and other animals. It extends the medial four digits of the hand. Extensor digitorum is innervated by the posterior int ...

extensor indicis In human anatomy, the extensor indicis roprius'' is a narrow, elongated skeletal muscle in the deep layer of the dorsal forearm, placed medial to, and parallel with, the extensor pollicis longus. Its tendon goes to the index finger, which it ex ...

extensor carpi radialis brevis In human anatomy, extensor carpi radialis brevis is a muscle in the forearm that acts to extend and abduct the wrist. It is shorter and thicker than its namesake extensor carpi radialis longus which can be found above the proximal end of the exten ...

, and extensor carpi radialis longus. These extensor muscles are supplied by the

posterior interosseous nerve The posterior interosseous nerve (or dorsal interosseous nerve) is a nerve in the forearm. It is the continuation of the deep branch of the radial nerve, after this has crossed the supinator muscle. It is considerably diminished in size compared ...

, a branch of the

radial nerve The radial nerve is a nerve in the human body that supplies the posterior portion of the upper limb. It innervates the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial comp ...

. Other muscles in the forearm that are innervated by this nerve are the supinator,

extensor pollicis brevis In human anatomy, the extensor pollicis brevis is a skeletal muscle on the dorsal side of the forearm. It lies on the medial side of, and is closely connected with, the abductor pollicis longus. The extensor pollicis brevis (EPB) belongs to the ...

extensor pollicis longus In human anatomy, the extensor pollicis longus muscle (EPL) is a skeletal muscle located dorsally on the forearm. It is much larger than the extensor pollicis brevis, the origin of which it partly covers and acts to stretch the thumb together w ...

and

abductor pollicis longus In human anatomy, the abductor pollicis longus (APL) is one of the extrinsic muscles of the hand. Its major function is to abduct the thumb at the wrist. Its tendon forms the anterior border of the anatomical snuffbox. Structure The abductor p ...

. All of these muscles are situated in the posterior half of the forearm (posterior is when it is in its standard

anatomical position The standard anatomical position, or standard anatomical model, is the scientifically agreed upon reference position for anatomical location terms. Standard anatomical positions are used to standardise the position of appendages of animals with r ...

). Also, the

brachioradialis The brachioradialis is a muscle of the forearm that flexes the forearm at the elbow. It is also capable of both pronation and supination, depending on the position of the forearm. It is attached to the distal styloid process of the radius by ...

anconeus The anconeus muscle (or anconaeus/anconæus) is a small muscle on the posterior aspect of the elbow joint. Some consider anconeus to be a continuation of the triceps brachii muscle. Some sources consider it to be part of the posterior compartmen ...

triceps brachii The triceps, or triceps brachii (Latin for "three-headed muscle of the arm"), is a large muscle on the back of the upper limb of many vertebrates Vertebrates () comprise all animal taxa within the subphylum Vertebrata () ( chordates with ba ...

and extensor carpi radialis longus are all innervated by muscular branches of the radial nerve in the arm.

Causes

Wrist extension is achieved by muscles in the forearm contracting, pulling on

tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

s that attach distal to (beyond) the wrist. If the tendons, muscles, or nerves supplying these muscles are damaged or otherwise 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–The radial nerve is the terminal branch of the posterior cord of the

brachial plexus The brachial plexus is a network () of nerves formed by the anterior rami of the lower four cervical nerves and first thoracic nerve ( C5, C6, C7, C8, and T1). This plexus extends from the spinal cord, through the cervicoaxillary canal in th ...

. A stab wound may damage the posterior cord and result in neurological deficits, including an inability to abduct the shoulder beyond the first 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. * Broken humerus–The radial nerve can be damaged if the

humerus The humerus (; ) is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius and ulna, and consists of three sections. The humeral upper extremity consists of a roun ...

(the bone of the arm) is broken because it runs through the radial groove on the lateral border of this bone along with the

deep brachial artery The deep artery of arm (also known as arteria profunda brachii and the deep brachial artery) is a large vessel which arises from the lateral and posterior part of the brachial artery, just below the lower border of the teres major. Structure It ...

. * Lead poisoning–Wrist drop is associated with

lead poisoning Lead poisoning, also known as plumbism and saturnism, is a type of metal poisoning caused by lead in the body. The brain is the most sensitive. Symptoms may include abdominal pain, constipation, headaches, irritability, memory problems, inferti ...

due to the effect of

lead Lead is a chemical element with the symbol Pb (from the Latin ) and atomic number 82. It is a heavy metal that is denser than most common materials. Lead is soft and malleable, and also has a relatively low melting point. When freshly cu ...

on the radial nerve. * Persistent injury–Persistent injury to the nerve is 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, extended leaning on the elbows, or regular upper body rope suspension. The colloquial terms for radial nerve palsy are derived from this cause. * Correcting dislocated shoulders–Radial nerve palsy can result from the now discredited practice of correcting a dislocated shoulder by putting a foot in the person's armpit and pulling on the arm in attempts to slide the humerus back into the glenoid cavity of the scapula. * Neuropathy in the hands and/or arms in patients with rheumatoid arthritis may in rare cases cause wrist drop. "When a joint swells, it can pinch the nerves of sensation that pass next to it. If the swelling irritates the nerve, either because of the inflammation or simply because of pressure, the nerve can send sensations of pain, numbness, and/or tingling to the brain. This is called nerve entrapment. Nerve entrapment most frequently occurs at the wrist (carpal tunnel syndrome) and elbow (ulnar nerve entrapment). A rare form of nerve disease in patients with rheumatoid arthritis that causes numbness and/or tingling is neuropathy. Neuropathy is nerve damage that in people with rheumatoid arthritis can result from inflammation of blood vessels (

vasculitis Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily caused b ...

)."

Types

Types of wrist drop are distinguished by the nerves affected: * Weakness of brachioradialis, wrist extension and finger flexion = radial nerve lesion * Weakness of finger extension and radial deviation of the wrist on extension = posterior interosseous nerve lesion * Weakness of triceps, finger extensors and flexors = c7,8 lesion * General weakness of upper limb marked in deltoid, triceps, wrist extension and finger extension = corticospinal lesion

Diagnosis

The workup for wrist drop frequently includes

nerve conduction velocity In neuroscience, nerve conduction velocity (CV) is an important aspect of nerve conduction studies. It is the speed at which an electrochemical impulse propagates down a neural pathway. Conduction velocities are affected by a wide array of factors ...

studies to isolate and confirm the radial nerve as the source of the problem. Other screening tests include the inability to extend the thumb into a "hitchhiker's sign". Plain films can help identify bone spurs and fractures that may have injured the nerve. Sometimes

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...

imaging is required to differentiate subtle causes.

Treatment

Initial treatment includes splinting of the wrist for support, along with

osteopathic medicine Osteopathy () is a type of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. Practitioners of osteopathy are referred to as osteopaths. Osteopathic manipulation is the core set of techniques in ...

physiotherapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...

and

occupational therapy Occupational therapy (OT) is a global healthcare profession. It involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or ''occupations'', of individuals, groups, or communities. The field of ...

. In some cases,

surgical Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

removal of bone spurs or other anatomical defects that may be impinging on the nerve might be warranted. If the injury was the result of pressure from prolonged use of improperly fitted crutches or other similar mechanisms of injury, then the symptoms of wrist drop will most likely resolve spontaneously within 8–12 weeks.

References

External links

* * {{DEFAULTSORT:Wrist Drop Arthropathies