Have you seen the parietal watch?

Wrist Drop

Topic: Anatomy

Created on Wednesday, January 3 2007 by

Last modified on Wednesday, January 3 2007.

A 68 year-old male defense attorney presents with wrist and finger drop.
He is unable to extend his arm at the elbow.
Abduction of the upper extremity at the shoulder is intact.
He is completely unable to extend the wrist.
Flexion of the wrist is weak.
Sensation is somewhat decreased on the lateral dorsal hand and posterior arm.

Of the following options, which is the most appropriate diagnosis?

 
        A) Posterior cord lesion
 
        B) Posterior interosseous neuropathy
 
        C) Radial neuropathy at the spiral groove
 
        D) Radial neuropathy in the axilla
 
        E) C7 radiculopathy
 

 


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This question was created on January 03, 2007 by .
This question was last modified on January 03, 2007.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) posterior cord lesion

This answer is incorrect.


This patient has a C7 radiculopathy. In posterior cord lesion, shoulder abduction is impaired, but in this patient it is intact. In posterior cord lesion, wrist flexion is intact, but in this patient it is impaired. In posterior cord lesion, sensation is decreased on the lateral dorsal hand and posterior arm, but in this patient it is variably decreased on the lateral dorsal hand and posterior arm.   (See References)

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B) posterior interosseous neuropathy

This answer is incorrect.


This patient has a C7 radiculopathy. In posterior interosseous neuropathy, elbow extension is intact, but in this patient it is impaired. In posterior interosseous neuropathy, wrist extension is partially spared with radial deviation, but in this patient it is absent. In posterior interosseous neuropathy, wrist flexion is intact, but in this patient it is impaired. In posterior interosseous neuropathy, sensation is intact, but in this patient it is variably decreased on the lateral dorsal hand and posterior arm.   (See References)

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C) radial neuropathy at the spiral groove

This answer is incorrect.


This patient has a C7 radiculopathy. In radial neuropathy at the spiral groove, elbow extension is intact, but in this patient it is impaired. In radial neuropathy at the spiral groove, wrist flexion is intact, but in this patient it is impaired. In radial neuropathy at the spiral groove, sensation is decreased on the lateral dorsal hand, but in this patient it is variably decreased on the lateral dorsal hand and posterior arm.   (See References)

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D) radial neuropathy in the axilla

This answer is incorrect.


This patient has a C7 radiculopathy. In radial neuropathy in the axilla, wrist flexion is intact, but in this patient it is impaired. In radial neuropathy in the axilla, sensation is decreased on the lateral dorsal hand and posterior arm, but in this patient it is variably decreased on the lateral dorsal hand and posterior arm.   (See References)

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E) C7 radiculopathy

This answer is correct.


This patient has C7 radiculopathy. In C7 radiculopathy, extension of the arm at the elbow is impaired, abduction of the shoulder is intact, wrist extension is likely to be absent, wrist flexion is impaired, and sensation is variably decreased on the lateral dorsal hand and posterior arm.   (See References)

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References:

1. Preston, D.C., and Shapiro, B.E. (2005). Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations, 2nd Edition. Elsevier, Philadelphia.
2. Moore, K.L. (1992). Clinical Oriented Anatomy, 3rd Edition. Williams & Wilkins, Baltimore.
3. Guarantors of Brain. (2000). Aids to the Examination of the Peripheral Nervous System, fourth edition. W.B. Saunders, Edinburgh.
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anatomy
Wrist Drop
Question ID: 01030700
Question written by . (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 01/03/2007
Modified: 01/03/2007
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