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Wrist Drop

Topic: Anatomy

Created on Wednesday, January 3 2007 by

Last modified on Wednesday, January 3 2007.

A 80 year-old male polar bear wrangler presents with wrist and finger drop.
He is able to extend his arm at the elbow.
Abduction of the upper extremity at the shoulder is intact.
He is able to weakly extend the wrist. When he does, the hand deviates radially.
Flexion of the wrist is intact.
Sensation is intact.

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

A) Radial neuropathy at the spiral groove

B) C7 radiculopathy

C) Radial neuropathy in the axilla

D) Posterior interosseous neuropathy

E) Posterior cord lesion

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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) radial neuropathy at the spiral groove

This answer is incorrect.

This patient has a posterior interosseous neuropathy. In radial neuropathy at the spiral groove, wrist extension is absent, but in this patient it is partially spared with radial deviation. In radial neuropathy at the spiral groove, sensation is decreased on the lateral dorsal hand, but in this patient it is intact. (See References)


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B) C7 radiculopathy

This answer is incorrect.

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


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C) radial neuropathy in the axilla

This answer is incorrect.

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


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D) posterior interosseous neuropathy

This answer is correct.

This patient has posterior interosseous neuropathy. In posterior interosseous neuropathy, extension of the arm at the elbow is intact, abduction of the shoulder is intact, wrist extension is likely to be partially spared with radial deviation, wrist flexion is intact, and sensation is intact. (See References)


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E) posterior cord lesion

This answer is incorrect.

This patient has a posterior interosseous neuropathy. In posterior cord lesion, elbow extension is impaired, but in this patient it is intact. In posterior cord lesion, shoulder abduction is impaired, but in this patient it is intact. In posterior cord lesion, wrist extension is absent, but in this patient it is partially spared with radial deviation. In posterior cord lesion, sensation is decreased on the lateral dorsal hand and posterior arm, but in this patient it is intact. (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
Estimated Permutations: 0