Wrist drop

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

Wrist drop is a condition where a person can not extend their wrist and it hangs flaccidly.

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).

Plain films can help identify bone spurs and fractures that may have injured the nerve.

Sometimes MRI imaging is required to differentiate subtle causes.

The workup for wrist drop frequently includes nerve conduction velocity studies to isolate and confirm the radial nerve as the source of the problem.

The goal of treatment is to allow you to use the hand and arm as much as possible. The health care provider should find and treat the cause, if possible. In some cases, no treatment is needed and you will recover slowly on your own. Initial management includes splinting of the wrist for support along with occupational or physical therapy. Medical causes such as diabetes and kidney disease should be treated.

In some cases surgical removal of bone spurs or other anatomical defects that may be impinging on the nerve might be warranted.

Avoid prolonged pressure on the upper arm.

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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]

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).

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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]

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.

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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]

Causes are:

• Injury
  • Crutch palsy, caused by improper use of crutches
  • Fracture of the humerus (upper arm bone)
  • Long-term or repeated constriction of the wrist (for example, from wearing a tight watch strap)
  • Pressure caused by hanging the arm over the back of a chair (Saturday night palsy if caused by drinking too much alcohol and falling asleep in that position)
  • Pressure to the upper arm from arm positions during sleep or coma
  • Pinching of the nerve during deep sleep, such as when a person is intoxicated
• In some cases, no cause can be found.

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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]

• Mild to severe deformity of the hand
• Partial or complete loss of feeling in the hand
• Partial or complete loss of wrist or hand movement
• Recurrent or unnoticed injury to the hand

If the cause of the nerve dysfunction can be found and successfully treated, there is a good chance that you will fully recover. In some cases, there may be partial or complete loss of movement or sensation. Nerve pain may be uncomfortable and may last for a long period of time. If this occurs, see a pain specialist to ensure you have access to all pain treatment options.

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