What is Drop Hand/Wrist Drop?

Wrist drop/ drop hand is symptom caused by damage to the radial nerve, which travels down the
arm and controls the movement of the triceps muscle at the back of the upper arm, because of
several conditions. This nerve controls the backward bend of wrists and helps with the movement
and sensation of the wrist and fingers
ANATOMY
Posterior Interosseous branch
(Motor)
Innervates the muscles of the
posterior forearm
Extend the wrist and finger
joints

Superficial branch (Sensory)

Innervates the dorsal surface of the lateral
three and half digits and the assosiated area
on the back of the hand
 EPIDEMIOLOGY
• Frequency
United States
Radial neuropathy is the fourth most common mononeuropathy
• Race
No Racial preponderance is known
• Sex
No gender Predilection has been observe
• Age
Radial neuropathy is reported in all age group
 ETIOLOGY
Clinical Relevance: Injury to The Radial Nerve
• Penetrating trauma
Penetrating trauma can cause injury anywhere
along the nerve
• Compression
Symptoms are dependent on the site of the lesion
The most common reported symptom is wrist drop.
 In The Axilla
• all radial-innervated muscles are
involved
• Motor functions – the triceps
brachii and muscles in posterior
compartment are affected.
• The patient is unable to extend at
the forearm, wrist and fingers.
(wrist drop)
• Sensory functions – all four
cutaneous branches of the radial
nerve are affected.
• There will be a loss of sensation
over the lateral and posterior arm,
posterior forearm, and dorsal
surface of the lateral three and a
half digits.
In The Radial
Groove
• all radial-innervated muscles distal
to the triceps are weak.
• Motor functions – The triceps
brachii may be weakened, but its
not paralysed
• Muscles of the posterior forearm
are affected. The patient is unable
to extend at the wrist and fingers.
(wrist drop)
• Sensory Functions –The superficial
branch of the radial nerve will be
damaged, resulting in sensory loss
on the dorsal surface of the lateral
three and half digits, and their
associated palm area
• Compression injuries at the humeral spiral groove occur in patients with sustained compression of this area over a
period of several hours.

– This is reported in patients who fall asleep in a drunken or drug-induced stupor with the arm over a chair
– Fracture of the humerus is a common cause of radial neuropathy due to compression or secondary
laceration of the nerve as it wraps around the humerus near the spiral groove.
– Radial neuropathy has also been reported in wheelchair users, when the spiral groove of the humerus is
compressed on a hard wheelchair surface.

Compression of nerve in axilla

or upper arm in patient sleeping
with arm over chair back
In The Forearm
 DIAGNOSIS
• History
• Clinical Examination
Inspection
Palpation
• Examination for Radial Nerve
 All the muscles innervated by the radial nerve should be tested
for strength and function
 Consists of ; motoric and sensory examination
 MOTORIC EXAMINATION
• Strength and function of the muscle innervated by the radial
nerve should be tested
• Consists of :
Arm Extensor Triceps brachii, Anconeus
Forearm Extensors Brachioradialis, ECRL
Supinator
Wrist Extensor ECRB, ECU
Finger Extensor ED, EDM, EI
Thumb Abduction Abductor Pollicis Longus
Thumb Extensors Extensor Pollicis Longus and Brevis
Arm Extensor

Forearm
Extensor

Forearm
Extensor
Thumb Thumb Extensors
Abduction

Thumb Extensors
Wrist Extensor Finger Extensor
 SENSORY EXAMINATION
Sensory examination of the radial nerve should include pin-prick and light touch testing of the
posterior arm and forearm and of the posterior lateral hand and thumb. Sensory loss over all of
these areas implicates a radial nerve lesion above the spiral groove, sensory loss over the
posterior lateral hand and thumb, with intact sensation over te posterior arm and forearm is
consistent with a SRN lesion or a radial nerve lesion at the spiral groove.
 DIAGNOSTIC TOOLS
a) EMG and Nerve Conduction Electrodiagnostic Study
b) Ultrasonography
c) Plain Radiography
d) MRI
 DIFFERENTIAL DIAGNOSIS
C7 Radiculopathy

Wrist drop is usually caused by a lesion of the radial nerve. Wrist extensor
weakness could also be caused by a C7 radiculopathy or a lesion of the middle
trunk of the brachial plexus, but these conditions can also sometimes affect
wrist flexion (through median and ulnar innervation)

sensory loss involving the palmar aspect of the

third finger would not be seen with a radial
neuropathy
TREATMENT AND MANAGEMENT
Treatment of radial nerve neuropathy can be
either non-operative or operative.
a. Non-Operative Treatment
b. Operative Treatment