Peer Reviewed

What's your diagnosis?

Weakness in the Upper Extremity After a Fall

Michael Grover, DO
Sethu Sandeep Koneru, MBBS
Volume 63 - Issue 5 - May 2023

  • AFFILIATIONS:
    1Associate Professor and Chairman, Department of Family Medicine, Mayo Clinic, Scottsdale, AZ
    2PGY-1 Internal Medicine Resident, Centinela Hospital Medical Center, Inglewood, CA

    CITATION:
    Grover M, Koneru SS. Weakness in the upper extremity after a fall. Consultant. 2023;63(5):e4. doi:10.25270/con.2022.10.000003.

    Received February 28, 2022. Accepted August 18, 2022. Published online October 3, 2022.

    DISCLOSURE:
    The authors report no relevant financial relationships.

    CORRESPONDENCE:
    Michael Grover, DO, Mayo Clinic, 13400 E Shea Boulevard, Scottsdale, AZ 85259 (Grover.Michael@mayo.edu)

    Introduction. A 58-year-old woman with debility from end-stage liver disease visited the clinic reporting weakness of her right upper extremity for the past day.

    Patient history. The patient had fallen from her bed and remained lying on the floor for several hours until help arrived. Her right arm was compressed under her body the entire time, and she said she was unable to extend her right wrist. She denied numbness and tingling in her right hand and had no pain.

    Physical examination. On physical examination, she could not fully extend her right wrist (Figure), but sensation was intact throughout. Her right-hand grip strength was normal. The intrinsic hand muscles of the lumbricals and interosseous muscles were intact. She had normal distal pulses and capillary refill. Results from a spurling test was negative. The rest of her nervous system examination was normal, including normal gait, vision, and speech, and she was negative for the Babinski sign.

    Figure. Photo shows the patient demonstrating right wrist weakness when asked to extend both hands.

    Answer and discussion on next page.

     

References

1. Silver S, Ledford CC, Vogel KJ, Arnold JJ. Peripheral nerve entrapment and injury in the upper extremity. Am Fam Physician. 2021;103(5):275-285.

2. Arnold WD, Krishna VR, Freimer M, Kissel JT, Elsheikh B. Prognosis of acute compressive radial neuropathy. Muscle Nerve. 2012;45(6):893-894. doi:10.1002/mus.23305

3. Sucher BM, Schreiber AL. Carpal tunnel syndrome diagnosis. Phys Med Rehab Clin. 2014;25(2):229-247. doi:0.1016/j.pmr.2014.01.004.

4. Yew KS, Cheng EM. Diagnosis of acute stroke. Am Fam Physician. 2015;91(8):528-536.

5. Castelli G, Desai KM, Cantone RE. Peripheral neuropathy: evaluation and differential diagnosis. Am Fam Physician. 2020;102(12):732-739.

6. Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Thera. 2005;28(5):345. doi:10.1016/j.jmpt.2005.04.005

7. Childress MA, Becker BA. Nonoperative management of cervical radiculopathy. Am Fam Physician. 2016;93(9):746-754.