A three-step method to evaluate a patient presenting with a wrist drop:
1. Arm position. Before assessing strength, place the patient's forearm and hand on their lap or another surface. The dropped wrist position (wrist hyperflexion) creates a biomechanical disadvantage for the forearm flexors and intrinsic hand muscles, often leading to an exaggerated perception of muscle weakness.
2. Identify which muscles are weak. In a central wrist drop, both the forearm flexors and intrinsic hand muscles are also weak. In a peripheral wrist drop, muscle strength of these muscles is usually normal, as radial mononeuropathy is the most common cause.
3. Make a fist. With the wrist dropping, instruct the patient to make a fist. If the wrist extends during this movement, it confirms a central lesion. In peripheral wrist drop, wrist extension either worsens or remains unchanged; it never extends. Wrist extension occurring with finger flexion is a synkinesia and hallmark of central wrist drop (video).
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«لو رُزِق العبد الدنيا ومافيها ثم قال الحمدلله؛ لكان إلهام الله له بالحمد أعظم نعمة من إعطائه له الدنيا؛ ﻷن نعيم الدنيا يزول، وثواب الحمد يبقى» — ابن القيّم
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