WHAT’S WRONG WITH THIS PATIENT? No. 4
Case number 4 is a 46 year old homeless male who was brought to the ER by a friend who lives in the same encampment as the patient. Mr. A, the patient, has a history of alcohol and drug abuse, lives alone in a tent, and sleeps on several blankets laying on the concrete sidewalk. However, the night before coming to the ER, he was very intoxicated, and while stumbling down an alley, he passed out, and fell to the alley floor, with the full weight of his body laying on his right arm positioned between him and the concrete. Nine hours later, when he “came to,” his right hand was very weak, he couldn’t straighten his fingers, he couldn’t hold anything with his right hand, nor could he dorsiflex (bend backwards) his right wrist. He felt a tingling sensation in the back of his right hand, as well.
On exam, his right hand was hanging downward. He could not straighten his fingers or wrist. His grip was very weak.Turning his hand palm up and palm down was very difficult and uncomfortable. Tapping the upper surface of his forearm with a reflex hammer at a certain spot, he could feel a severe tingling in the back of his hand and wrist. He was very upset that he couldn’t use his right hand and arm. X-rays of his upper arm and forearm bones were negative.
What’s wrong with this patient? He has a right radial nerve palsy, or “Saturday night palsy.”
The forearm has three main nerves; the radial, median, and ulnar nerves. They originate in the cervical spine (neck), run down the inside of the upper arm, and then branch into three nerves in the forearm. The ulnar nerve runs on the inside of the elbow down to the 4th and 5th fingers enabling the two fingers to flex and become part of the grip. It also causes the fingers to spread apart.
The median nerve runs under the skin of the palm up side of the forearm, through a ligamentous tunnel in the wrist, the carpal tunnel, into the thumb, index and middle fingers causing them to flex and form part of the grip.
The radial nerve runs over the surface of the radius bone and causes extension (straightening) of the wrist and fingers. When the radial nerve is compressed, as it was for the nine hours he was laying on his right arm, it causes a “wrist drop”—the inability to straighten and upward flex the wrist and fingers. The hand and wrist become useless.
Ulnar compression cause ulnar palsy—inability to use 4th and 5th fingers.
Median nerve compression causes carpal tunnel syndrome which affects the thumb, index, and middle fingers.
What’s wrong with this patient? Radial nerve compression resulting in radial nerve palsy with a wrist drop. Will this get better? It depends on several factors including the degree of compression on the nerve. Physical therapy was the treatment prescribed.
Reference: www.Google.com/wrist-drop-causes.
