On 5/29/2009 6:27:39 AM, Sani Hlais (Family Medicine) wrote

The differential diagnosis includes radial nerve palsy (but it is not probable due to the absence of sensory symptoms), cervical radiculitis (but no neck pain, and pure motor). I think the first diagnosis to rule out would be a CVA (motor deficit unilateral with no pain in a high risk patient; RA puts the patient at a high cardiovascular risk). I would begin with a cerebral MRI.

On 6/3/2009 4:16:46 AM, Jumana (Antoun) wrote

Where would be the lesion in the brain to just give a wrist drop; if you are considering CVA you would refer to ER immediately for MRI or just go through the regular channels of taking appointments and perfomring MRI

On 6/12/2009 9:54:51 AM, joumana zeineddine (family medicine) wrote

i think that this a case of "posterior interosseus nerve palsy" which is secondary to the compression of the motor branch of the radial nerve at the elbow level.the treatment should be surgical and urgent to prevent permanent damage to the nerve

On 6/12/2009 10:09:58 AM, joumana zeineddine (family medicine) wrote

we should do MRI to eliminate a compression secondary to tumor. in this case a synovitis seconadry to rheumatoid arthritis may be a cause. the surgery is needed only if there is a tumor

On 7/20/2009 1:28:01 PM, Charbel Bou Yazbek (Family Medicine) wrote

Hi, could it be a rupture of the extensor digitorum communis caused by occupational overuse giving that he cleans windows ? I suppose he is a right-handed man.

On 7/22/2009 8:02:35 AM, Raafat ammar (ICU) wrote

I woudld suggest mononeuropathy of the radial nerve Is he diabetic? then post interosseous nerve palsy

On 7/23/2009 6:01:44 AM, Charbel Bou Yazbek (Family Medicine) wrote

This patiant has an isolated wrist drop with no sensory or motor signs except the inability to extend his wrist with a conserved motor power of the fingers. No motor nerve palsy can explain this presentation. I would suggest a rupture of the wrist extensor tendons as it is a known complication of Rhumatoid Arthritis wrists facilitated by occupational overuse. an MRI or an ultrasound of the wrist would confirm the diagnosis.

On 7/24/2009 10:13:16 AM, Marouan Zoghbi (FM) wrote

The posterior interosseous nerve controls finger extension, and to a small degree, wrist extension.since fingers motricity is not affected , and knowing that this patient has RA, I think tendon rupture is the most likely diagnosis.

On 7/24/2009 10:14:33 AM, Marouan Zoghbi (MF) wrote

Musculoskelettal ultrasound of both wrists would be helpful in establishing the diagnosis

On 7/29/2009 6:24:50 AM, Dr Wassim Abdel Khalek (Family Medicine) wrote

Most probably this patiente suffer from Radial Nerve Palsy.Acording to his social history and abscence of trauma,most probably his work cleaning windows daily can cause radial nerve injury. First thing to do es EMG to see nerve conduction velocity and eventuallly MRI to rule out other causes.Splinting and rest of the arn may help recovery should there is no other surgical treatment. Dr Wassim Abdel Khalek Spain

On 9/13/2009 9:22:25 PM, Louna Mohammad () wrote

The differential diagnosis includes: -1-Carpal Tunnel syndromedue (due to a narrowing in the path of the median nerve. or another nerve compression at the level of the wrist like the radial nerve palsy typical of repetitive movements) -2-Guillain-Barré syndrome -3-or Myasthenia Gravis(associated with rheumatoid arthritis). The workup might be nerve conduction velocity studies to isolate and confirm the radial nerve as the source of the problem. -Plain films can help identify bone spurs and fractures that may have injured the nerve. -An MRI imaging can be required to differentiate subtle causes. -and serologic tests to investigate for the presence of autoantibodies.

On 9/25/2009 10:48:23 PM, Asma Tarabah () wrote

-1-If the pt had Posterior Interosseous Nerve Palsy he would have a weakness in his finger and thumb extension, and this is not the case. -2-Guillain-Barré syndrome is also not a differential diagnosis since in this syndrome the weakness starts in the legs then progresses upward. -3-If the pt had Myasthenia gravis then he would have atleast dysphagia, diplopia or dysarthria, which is not the case. -4-Carpal Tunnel syndrome is not likely to fall under this case since the patient's fingers are not affected. The differential diagnosis is most probably radial nerve palsy. Tests may include EMG, nerve conduction velocity study(to determine the location of the nerve injury). Initial management includes splinting of the wrist for support.