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What Can Cause a Wrist Drop?

What Can Cause a Wrist Drop?

Have you ever felt pins and needles in your hand or fingers? This strange sensation is a sign of a mild nerve compression. While we are awake, these compressions are easily resolved, as we can recognize the symptoms and adjust our body position accordingly. While we are asleep, however, we cannot always respond to these compressions, which can cause consequences during waking hours.

Wrist drop is a symptom of radial nerve palsy in which a person cannot lift the wrist after placing it over a table. For example, if you hold your hand parallel to the floor with the back of your hand facing the ceiling, let your hand hang limp where the fingers point downward. A person with a wrist drop cannot lift their hand upward in which the fingers are pointing toward the ceiling.

What is the radial nerve and what does it do?

The radial nerve is one of the three major nerves that sense feeling and control the muscles in your arm. It travels from your neck and down the back of your arm all the way into the hand. The muscles controlled by the radial nerve allow you to straighten out your elbow, extend your wrist up as if getting ready to throw a dart, and even make a “thumbs up” sign.

The radial nerves are responsible for:

  1. Controlling the movement of the triceps muscle located at the back of the upper arm

  2. Extending the wrist and fingers

  3. Controlling sensation

Any trauma or injury to the radial nerve due to repeated usage or other factors can lead to radial nerve palsy.

How can compression of the radial nerve affect you?

Prolonged compression of the radial nerve can happen in many ways. Radial nerve compression most often happens while sleeping with your head resting on your arm. If you sleep in a position that causes radial nerve compression, you may wake up experiencing numbness and tingling along the back of your arm, forearm, and hand. With more severe compression, you may also experience “wrist drop.” With wrist drop, your wrist becomes limp, and is unable to extend up. This can cause significant functional problems, making it difficult to lift even small items in your hand.

Think of a nerve like a highway and nerve signals like cars. A healthy nerve (the highway) will allow nerve signals (the cars) to flow freely, allowing you to control your muscles. A nerve compression is like traffic on that highway, meaning that nerve signals won’t get to reach the muscles, causing weakness and a loss of muscle control.

What are the symptoms of a wrist drop?

  • Wrist hangs limp

  • Unable to lift the wrist

  • Problems stretching or aligning the wrist or fingers

  • Difficulty making a fist

Besides a wrist drop, other symptoms of radial nerve palsy affecting a person’s arm, wrist, hand, and/or fingers may include:

  • Loss of function 

  • Pinching and grasping problems

  • Pain

  • Weakness

  • Numbness

  • Inability to control muscles

Who has the most significant risk of radial nerve palsy?

Several risk factors can increase the likelihood of getting radial nerve palsy, including:

  • Gender: Radial nerve palsy is more common in men than in women.

  • Occupational risks: Jobs that involve repetitive motion and awkward postures or working positions may increase the risk of radial nerve palsy.

  • Other injuries: People getting exposed to frequent injuries such as broken bones, dislocation, significant bruises, and injuries requiring the use of crutches are at a high risk of radial nerve palsy.

What is the treatment? 

After proper diagnosis from a physician, you will most likely see a certified hand therapist. It may take several weeks to heal from a radial nerve palsy, and a CHT will be able to monitor progress and facilitate functional use of your hand during the healing process. If you have wrist drop, a CHT can make you a custom splint that will keep your wrist straight and allow you to bend your fingers. This type of splint will protect the joints in your wrist and hand from becoming contracted if you have wrist drop and allow you to continue using your hand to grasp objects while the nerve heals. Your hand therapist will also design a program of exercises that will help you continue to perform your daily activities and eventually regain strength in your hand and wrist.


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