Wristdrop
Wristdrop: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
In wristdrop, the hand remains in a flexed position from paresis of the extensor muscles of the hand, wrist, and fingers. This weakness may be slight or severe and temporary or permanent. Wristdrop may occur unilaterally and suddenly after a radial nerve injury, or bilaterally and gradually in a neurologic disorder, such as myasthenia gravis, Guillain-Barré syndrome, or multiple sclerosis.
History and physical examination
Begin by asking the patient when wristdrop began and if he can extend his hand at all. Also ask about associated signs and symptoms, such as muscle weakness, vision disturbances, difficulty swallowing or chewing, and urinary incontinence. Has he recently injured his arm or axilla? Test the extent of his wristdrop by asking him to make a fist. Try to pull the fist down. If he can’t resist your pull, his extensor muscles are weak. Test complete range of motion in the arm to detect radial nerve injury. Is there an area of numbness over the “snuffbox” areas of the hand—a sign of radial nerve damage?
If the patient reports leg or arm weakness or vision disturbances, proceed with a complete neurologic examination. Assess his level of consciousness; cranial nerve, motor, and sensory function; and reflexes. Are other areas weak? If so, does the weakness increase with fatigue and decrease with rest, as in myasthenia gravis? Does the patient have exacerbations and remissions of signs and symptoms, suggesting multiple sclerosis, or rapidly ascending weakness, indicating Guillain-Barré syndrome?
Medical causes
Guillain-Barré syndrome
Wristdrop may occur in this syndrome, but the primary neurologic sign is diffuse muscle weakness that typically begins in the legs and ascends to the arms and facial nerves within 24 to 72 hours. Associated findings include paresthesia, diminished or absent corneal reflexes, dysarthria, hypernasality, dysphagia, respiratory insufficiency, and possibly respiratory paralysis. Sympathetic nerve dysfunction—such as orthostatic hypotension, loss of bladder and bowel control, diaphoresis, and tachycardia—may also occur.
Multiple sclerosis
This disorder may cause wristdrop, but the earliest symptoms are usually diplopia, visual blurring, and paresthesia. Other findings include nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, gait ataxia, dysphagia, dysarthria, urinary dysfunction, impotence, and emotional lability.
Myasthenia gravis
In this disorder, weakness causes wristdrop. Associated findings vary with the muscle group affected and may include weak eye closure, ptosis, diplopia, masklike facies, difficulty chewing and swallowing, nasal regurgitation of fluids, and hypernasality. Weakened neck muscles may lead to head bobbing. Respiratory muscle weakness produces myasthenic crisis.
Radial nerve injury
Compression, severance, or inflammation of the radial nerve causes a loss of motor and sensory function in the involved area. This may result in wristdrop, which may be temporary if the injury is incomplete. Other findings in radial nerve injury include loss of finger and elbow extension, forearm supination, and thumb abduction; paresthesia and numbness; and hand muscle atrophy.
Other causes
Lead poisoning
Inorganic lead poisoning may cause a motor neuropathy that typically involves the radial nerve.
Special considerations
Help the patient with wristdrop perform routine tasks of eating and maintaining personal hygiene. If his wristdrop is permanent, contact a physical therapist to teach him range-of-motion exercises to strengthen weakened muscles. Contact an occupational therapist to provide assistive devices, such as a swivel spoon with a cuff that enables the patient to feed himself. Apply splints to help prevent contractures. Remind the patient to avoid holding hot objects in the affected hand. Also, teach the family to assist with routine activities.
Pediatric pointers
Radial nerve injury is the most common cause of wristdrop in children.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Wrist/Hand Pain (Field Guide to Bedside Diagnosis)
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