Drop wrist deformity, also known as Saturday Night Palsy is a disorder where a person cannot extend the wrist and it hangs limply. This is known as wrist drop. When muscles in the forearm contract the wrist can be extended. However, when the tendons, muscles, and nerves reaching these muscles are not working properly, a condition called Drop wrist deformity may occur. This condition is also called Radial Nerve Palsy as damage to the radial nerve due to a broken humerus bone can result in this immobility of the wrist.
Causes of drop wrist deformity
Stab wounds to the chest, a broken arm and lead poisoning are some of the causes for this disorder. External pressure applied to the radial nerve or repeated usage of this nerve due to the use of crutches or leaning on the elbows can also cause this condition. The term Saturday night palsy is used colloquially to refer to radial nerve damage that can take place if a drunk person falls asleep with the back of his arms compressed by an object similar to a bar edge.
Sports activities can also cause damage. Sitting with an arm wrapped around your neighbor's chair for too long or sleeping with your head rested on another person's arm may cause radial nerve damage. Applying pressure on the nerve for too long or wearing a wrist watch that is too tight may also cause nerve damage. However, any damage to the nerve is generally preceded by intense pain that can only be ignored if a person is highly intoxicated, hence the term is applied. Diabetes Mellitus may also cause this disorder.
Diagnosis of Radial Nerve Palsy
Nerve conduction velocity studies help to confirm that the radial nerve is the source of the problem. Plain films help identify fractures or bone spurs that could have led to radial nerve injury. Magnetic Resonance Imaging may also be used to identity more subtle causes. More importantly, people have to be vigilant and watch out for signs of damage as most of the time it occurs when a person is unaware of what is happening at the time. Nerve biopsy and electromyography tests may also be conducted.
Symptoms of wrist drop
Being unable to move the wrist upwards with the hand is facing palm down, numbness in the wrist area and back of the hand and inability to straighten the fingers are common symptoms. The muscles the radial nerve controls and the skin sensitivity that exists as a result of it, both do not function when Saturday night palsy occurs.
It causes weakness and numbness. The thumb and forearm may be affected. Decreased sensation, tingling or burning sensation are some of the symptoms. Acute toe pain in both the feet, blanching of the fingers, breast weakness, bowel incontinence and pain in the extremities are some of the symptoms.
You should immediately consult your doctor if you suspect Saturday night palsy. The doctor will usually first make a note of your previous or current injuries or swellings and activities. Conservative therapy of physical therapy includes minimizing muscle loss and splinting of the wrist is the first measure that is usually taken to support the wrist. The goal of any treatment is to maximize the range of movement of the arm and fingers. By keeping the wrist straight, one can accomplish small things like writing a sentence or two or pick up a tiny object.
Occupational or physical therapy may be provided additionally. Bone spurs may be surgically removed with any other sources of anatomical defects. The prognosis is somewhat optimistic for the disorder in that the nerve can regenerate itself, but complete regeneration may or may not occur, and this may take several months or years. It is a myth that squeezing rubber balls to exercise the arms helps, as it exercises muscles different than the ones affected.
Exercises that focus on lifting the wrist and extending the fingers ought to be practiced. However, these too may not be effective as the nerves that activate these muscles do not function. Passive range of motion exercises may be implemented by using the uninjured arm and stretching out the weak muscles.
Proper nutrition is necessary to help the damaged nerve to regenerate and vitamin supplements may help the process. Abstinence from drinking may help prevent further injury. The chances for recovery depend on the location and severity of the trauma. Sometimes, a person may recover in just a matter of hours. In most cases, treatment is not required and the persons will recover on their own.
Medications include analgesics to reduce the intense pain. Phenytoin, carbamazepine, or tricyclic antidepressant may also be recommended to reduce the pain. Steroids may be used in some cases to reduce the swelling that presses on the nerve. Braces or other tools may be needed if the case is rather severe.
The person may have to undergo job counseling and make appropriate work and lifestyle changes to cope with the limited functionality of the wrist. In a few cases severe complications such as deformity to the hand, partial or complete loss of sensation or movement in the forearm and wrist or recurrent injury may occur. People who are dependent on their wrists for a living such as stringed instrument players may lose not only their livelihood and may become depressed. Adequate counseling facilities must be at hand for them.