Discussions By Condition: I cannot get a diagnosis.

Sudden onset of limp wrist, unable to move wrist

Posted In: I cannot get a diagnosis. 13 Replies
  • Posted By: Anonymous
  • May 24, 2009
  • 09:28 PM

Twenty-two year old male, woke up with his wrist flexed down, un able to move his wrist. He also had numbness, tingling in left arm, hand and fingers. He could not touch his fore finger and thumb in the position of the "OK" sign. He could not give a "thumbs up" sign. He has reduced grip strength in the left hand. He denies any accident or trauma prior to the finding of the wrist. He has had a slight tremor in his hands since high school.

He had an MRI two days later, and it did not reveal anything unusual.

The doctor started him on an anti imflammatory drug and ordered physical therapy. He has two physical therapy treatments with the use of a tens unit. He has some movement back. He can flex his wrist level with his arm, but he cannot hold it there. He still can not flex the wrist in the cocked up position.

The doctor sems to think he might have damaged the axilla nerve bundle in his left armpit because he slees with his left arm up under his head.

I am concerned because of the sudden onset, it has not resolved itself and because he graduated from college two weeks ago, he is no longer covered by parents' insurance as of June 1.

any suggestions?

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13 Replies:

  • Okay, this is known as radial nerve palsy and is actually more common than one might think. The cause in this instance is due to transient nerve entrapment by either leaning for an over-extended period on the elbow of the affected wrist or extended pressure at the plexus located in the axilla region. In the latter case, persons having to use crutches for instance have a greater risk of developing a wrist drop or radial palsy due to nerve compression at the plexus by the head of the crutch. Repetitive motion has also been known to result in a radial palsy in some cases, although less common. I don't think an MRI is as warranted here as a nerve conduction velocity to determine whether and to what extent the radial nerve is affected. In some instances, bone spurs or fractures can result in a wrist drop and in these case, imaging studies would help identify the cause. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Thank you Dr. Cottle. I appreciate your input. I failed to mention earlier that he was diagnosed two years ago with an unfused S1 and S2 disc. (I do not know what that means.) Could the S1 and S2 irritate the wrist? Do you think he sould return to his family practice doctor. Do family practice doctors or physical therapists do nerve conduction velocity testing? I sincerely appreciate you.
    Anonymous 42,789 Replies Flag this Response
  • Well, an unfused sacrum or S1/S2 would anatomically be on the other end of things, so to speak. Nerves that exit the sacral foramen innervate areas of the legs and feet. In cases of an unfused sacrum, the joints have a tendency to become misaligned in a posterior direction and can cause considerable discomfort. The condition, however, is congenital in nature and not due to any type of incident around the time of its discovery. Conduction velocity tests are typically performed within the specialty of neurology. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Thank you for your help. I did an internet search of radial nerve palsy and learned that radial nerve palsy is also referred to as "Saturday Night Palsy". The article indicated the recovery from the wrist drop could take days or much longer, even up to a year, depending on the severity of damage to the nerve fibers. We will seek the nerve conduction velocity test you mentioned. If I understand the nerve conduction velocity test correctly, it can help a doctor to understand the extent of nerve damage. I am including the link to the web page where I read about "Saturday Night Palsy". Again, I thank you for your information.http://www.cordingleyneurology.com/radialneuropathy.html
    Anonymous 42,789 Replies Flag this Response
  • Well, thank you for the link but as an old retired neurologist, I'm all too familiar with the term Saturday Night Palsy :) Nevertheless, I'll go take a look at the link when I have time. The conduction velocity test will tell your doctors whether the radial nerve is responsible for the condition, as well as the extent of involvement. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Hello Dr. Cottle,It was quite startling to witness the sudden onset of wrist drop and then to watch my son's inability to move his wrist. It was downright weird! I thought at first he was messing with me, just to get a rise. When I realized he was not teasing me, I wanted him to go to the emergency room. He refused to go to the ER on a Sunday morning. He opted to wait until Monday morning. That was a long 24 hours.Please know that I appreciate your willingness to share your bank of knowledge. You have encouraged me by sharing your time and wisdom. Because of your input, I'm at rest, and confident that his condition will eventually be resolved. I will pursue the conduction velocity test. I look forward to learning more about the radial nerve and if it is responsible for the condition, and the extent of involvement. Kind regards,:)
    Anonymous 42,789 Replies Flag this Response
  • More physical therapy, more time being mobile, etc.
    Anonymous 42,789 Replies Flag this Response
  • Thank you for your suggestion.
    Anonymous 42,789 Replies Flag this Response
  • Hello npcomplete,Thank you for your suggestion of physical therapy and being mobile. He is going to physical therapy and doing prescribed hand exercises at home. Thank you for your response.
    Anonymous 42,789 Replies Flag this Response
  • Good suggestion blaze - except it is much more likely that such devices damage the way he uses his body (and thus his nerves) than through any sort of non-ionizing radiation. Pferg, because the body is interconnected, I recommend doing a lot more than hand exercises, get him to start swimming, running, or any activity he may enjoy.
    Anonymous 42,789 Replies Flag this Response
  • Hello npcomplete,He wants to go to the gym. I have not a clue if that is a good idea. I don't know what he does at the gym. I know he cannot grip anything, can not open a milk carton or jar, cannot button his shirt ... I don't know if he is capable of causing more damage.
    Anonymous 42,789 Replies Flag this Response
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  • Yeah, definitely don't use weights - if he was going to the gym when this problem started, then the damaged nerve could easily be attributed to weight lifting.Stick with aerobics and stuff that emphasizes full body and evenly distributed mobility (like swimming). Your physical therapists should be recommending such activities.
    Anonymous 42,789 Replies Flag this Response
  • We think this incident is a result of him sleeping on his left arm extended over his head. He has not been going to the gym. He just finished his last semester of college, so he was looking forward to going to the gym. Unfortunately, once he graduated from college, he no longer is covered on our insurance after June 1.He went to the doctor today. The doctor thinks this will resolve in 4 to 6 weeks. We are going to buy Cobra insurance until this issue resolves. Hopefully after this resolves, he will be able to buy his own medical insurance. :)
    Anonymous 42,789 Replies Flag this Response
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