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Wrist drop

Synonym: drop hand, flaccid drop of the hand
German: Fallhand

1 Definition

A wrist drop is present when a dorsiflexion of the wrist is not, or only in a very limited way, possible. It will present itself clinically as a flaccid hanging down of the hand. A wrist drop often occurs in the context of a lesion of the radial nerve.

2 Differential diagnosis

Wrist drop can occur because of various neurological disorders:

  • Peripheral paresis: Injury along the path of the radial nerve.
  • Central paresis ("central drop hand"): In case of the rare central drop hand normally an involvement of the finger flexors, which are not innervated by the radial nerve, a disorder of the intrinsic hand muscles (fine motor skills), as well as further neurological malfunctions (reflex deficits, sensory disturbances) can be noticed.
  • Central disturbance of the innervation of the extensor muscles of the wrist (when gripping an object forcefully, the wrist extensor muscles are simultaneously activated).

3 Symptoms

The more proximal the area of a radial nerve lesion is, the more muscles groups will be affected. A distal lesion often will not lead to the development of a wrist drop. A lesion in the middle part of the nerve should present with the typical wrist drop and a pronation position of the forearm. In addition to that, a distal lesion often prohibits an extension of the elbow. When trying to form a fist when a wrist drop is present, a strength reduction will also be observed. This is due to the flexor muscles already shortening at rest, because of the absence of the extensor muscles.

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