Wrist drop is a medical condition in which the

wrist In human anatomy, the wrist is variously defined as (1) the 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 as the carpal ...

and the

fingers A finger is a prominent digit on the forelimbs of most tetrapod vertebrate animals, especially those with prehensile extremities (i.e. hands) such as humans and other primates. Most tetrapods have five digits (pentadactyly), Chambers 1998 p. 60 ...

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 ...

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

muscle Muscle is a soft tissue, one of the four basic types of animal tissue. There are three types of muscle tissue in vertebrates: skeletal muscle, cardiac muscle, and smooth muscle. Muscle tissue gives skeletal muscles the ability to muscle contra ...

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 used to describe the entire appendage of the upper limb, but which in anatomy, techn ...

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 car ...

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 t ...

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 in ...

extensor indicis In human anatomy, the extensor indicis (proprius) 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 ext ...

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 ext ...

, and

extensor carpi radialis longus The extensor carpi radialis longus is one of the five main muscles that control movements at the wrist. This muscle is quite long, starting on the lateral side of the humerus, and attaching to the base of the second metacarpal bone (metacarpal of ...

. These extensor muscles are supplied by the

posterior interosseous nerve The posterior interosseous nerve (or dorsal interosseous nerve/deep radial 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 diminish ...

, 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 compartment of the ...

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

supinator In human anatomy, the supinator is a broad muscle in the posterior compartment of the forearm, curved around the upper third of the radius (bone), radius. Its function is to supination, supinate the forearm. Structure The supinator consists of tw ...

extensor pollicis brevis In human anatomy, the extensor pollicis brevis (EPB) 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 belongs to t ...

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 abducto ...

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

anatomical position Anatomical terminology is a specialized system of terms used by anatomists, zoologists, and health professionals, such as doctors, surgeons, and pharmacists, to describe the structures and functions of the body. This terminology incorpor ...

). 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 way ...

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 compartment ...

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. It consists of three parts: the medial, lateral, and long head. All three heads cross the elbow jo ...

and

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 band of fibrous connective tissue, dense fibrous connective tissue that connects skeletal muscle, muscle to bone. It sends the mechanical forces of muscle contraction to the skeletal system, while withstanding tensi ...

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 clavicle, collarbone, or keybone is a slender, S-shaped long bone approximately long that serves as a strut between the scapula, shoulder blade and the sternum (breastbone). There are two clavicles, one on each side of the body. The clavic ...

–The

is the terminal branch of the posterior cord of the

brachial plexus The brachial plexus is a network of nerves (nerve plexus) formed by the anterior rami of the lower four Spinal nerve#Cervical nerves, cervical nerves and first Spinal nerve#Thoracic nerves, thoracic nerve (cervical spinal nerve 5, C5, Cervical spi ...

. 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 (; : humeri) 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 (bone), radius and ulna, and consists of three sections. The humeral upper extrem ...

(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 deep brachial artery) is a large artery of the arm which arises from the brachial artery. It descends in the arm before ending by anastomosing with the radial recurrent artery. Structure Origin The deep ...

. * 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. Symptoms may include abdominal pain, constipation, headaches, irritability, memory problems, infertility, numbness and paresthesia, t ...

due to the effect of

lead Lead () is a chemical element; it has Chemical symbol, symbol Pb (from Latin ) and atomic number 82. It is a Heavy metal (elements), heavy metal that is density, denser than most common materials. Lead is Mohs scale, soft and Ductility, malleabl ...

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

back into the

glenoid cavity The glenoid fossa of the scapula or the glenoid cavity is a bone part of the shoulder. The word ''glenoid'' is pronounced or (both are common) and is from , "socket", reflecting the shoulder joint's ball-and-socket form. It is a shallow, pyri ...

of the

scapula The scapula (: scapulae or scapulas), also known as the shoulder blade, is the bone that connects the humerus (upper arm bone) with the clavicle (collar bone). Like their connected bones, the scapulae are paired, with each scapula on either side ...

. * 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 artery, arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily c ...

)."

Types

Types of wrist drop are distinguished by the nerves affected: * Weakness of

, wrist extension and finger flexion = radial nerve lesion * Weakness of finger extension and radial deviation of the wrist on extension =

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 the speed at which an electrochemical impulse propagates down a neural pathway. Conduction velocities are affected by a wide array of factors, which include age, sex, and various medical conditio ...

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 generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...

imaging is required to differentiate subtle causes.

Treatment

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

osteopathic medicine Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic Medical school in the United States, medical schools in the United States. DO and Doctor of Medicine, Doctor of Medicine (M ...

physiotherapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...

and

occupational therapy Occupational therapy (OT), also known as ergotherapy, is a healthcare profession. Ergotherapy is derived from the Greek wiktionary:ergon, ergon which is allied to work, to act and to be active. Occupational therapy is based on the assumption t ...

. In some cases,

surgical Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...

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