This document discusses wrist drop, finger drop, and foot drop caused by radial nerve palsy. It provides details on the anatomy of the radial nerve and explains how injuries at different points can cause wrist drop or finger drop. For foot drop, it describes the anatomy of the leg and discusses how peroneal nerve injuries or issues with the sciatic nerve or L5 root can cause weakness of the dorsiflexors. It outlines the clinical features, diagnostic process, and treatment options including conservative care, physical therapy, splinting, and in some cases surgery.

1. WRIST DROP,FINGER DROP,
FOOT DROP
DR.PARVATHY RAJU.P
JUNIOR RESIDENT

2. Anatomy of radial nerve
The radial nerve is a continuation of posterior
cord of brachial plexus
It is largest nerve of brachial plexus
Supplies posterior compartment of UL.
Carries fibres from all roots(C5,C6,C7,C8&T1)
of brachial plexus

4. Course in Axilla
• It lies posterior to third part of axilary artery
• Gives of 3 branches
1.Posterior cutaneous nerve of arm
2.Nerve to long head of triceps
3.Nerve to medial head of triceps

9. High Radial Nerve Palsy-WRIST DROP
• Injury proximal to elbow- wrist, fingers and
thumb extension are lost result in wrist drop.
• Patient loses the ability to extend the wrist,
fingers and thumb, that are essential for
grasp.
• Loses grip strength because cannot stabilise
wrist during power grip.

11. FINGER DROP

12. Low radial nerve palsy-FINGER DROP
• Defined as injury to PIN ,occurs distally to
elbow, wrist extension is preserved because
ECRL remains intact.
• If PIN Injured proximally, ECU function may be
lost, resulting radial deviation .
• If PIN Injured distally, the ECU function is
preserved(no radial deviation) and wrist
extension remains balanced .

13. ETHIOLOGY
• Crutch palsy
• Compression neuropathies-Saturday night
palsy
• Humeral fractures
• Iatrogenic-during surgery
• Prolonged application of tourniquet
• Intramuscular injection

16. Treatment of radial palsy
• Non operative-full passive range of motion in
all joint of wrist and hand and prevention of
contractures , including that of the thumb –
index web.
• Splint-cock up splint

18. OPERATIVE MANAGEMENT
• Nerve repair
• Neurolysis
• Tendon transfer

19. 3 main goals :
 Restoration of finger extension
 Restoration of thumb extension
 Restoration of wrist extension

20. FOOT DROP
• Foot drop refers to an inability to lift the
forefoot due to weakness of the dorsiflexors.
• This condition may be the result of a
muscular, skeletal, or nervous system
problem.

21. LOWER EXTREMITY ANATOMY
• Thigh – The thigh contains three muscle
compartments, the anterior, medial, and
posterior compartments, named after their
relationship to the femur .

23. LEG
• The leg contains 4 compartments
named in relation to the tibia and fibula .
• Anterior compartment – The anterior
compartment contains the tibialis anterior,
extensor hallucis longus, extensor digitorum
longus, and peroneus tertius muscles.
These muscles dorsiflex and invert/evert the
ankle and extend the toes. The arterial supply
is the anterior tibial artery, and the motor
nerve is the deep peroneal nerve .

24. Lateral compartment – The lateral compartment
contains the peroneus longus and peroneus brevis
muscles .
They evert the foot at the ankle and weakly
plantar flex the foot. The peroneal artery and
superficial peroneal nerve supply these muscles .

25. • The posterior compartments contains the
muscles that plantarflex and invert the foot at the
ankle and flex the toes.
• The posterior tibial and peroneal arteries supply
both compartments. and innervatinnervated by
tibial nerve.
• The superficial posterior compartment contains
gastronemius, soleus, and plantaris .
• The deep posterior compartment contains the
tibialis posterior, flexor hallucis longus, flexor
digitorum longus, and popliteus muscles.

26. SENSORY SUPPLY OF LEG

27. anatomical localisation of foot drop
• Peroneal nerve injury .
• Sciatic nerve .
• L5 radiculopathy .
• Anterior horn cell involvement.
• Stroke .

28. Etiology
• Compressive .
• Compressive etiologies are the most common
cause of peroneal nerve palsies.
• These occur anywhere along the course of the
nerve.
• Compression of the common peroneal nerve
at the level of the fibular head is the most
common site of entrapment .

29. • Trauma — Traumatic injuries are the second
most common cause of peroneal nerve palsy.
• Compartment syndrome — Compartment
syndromes affecting the leg, either due to
trauma or related to ischemia-reperfusion
injury, can lead to peroneal nerve ischemia
with subsequent foot drop.

30. • Iatrogenic — Foot drop secondary to
iatrogenic causes is seen most frequently due
to surgical procedures or protracted
positioning in anesthesia .

31. • Neurologic disorders — Primary and
secondary neurologic disorders are other
causes of foot drop.
• Charcot-Marie-Tooth, a primary peripheral
nerve disorder is the most commonly
inherited peripheral nerve disorder. It affects
both sensory and motor nerves.
• amyotrophic lateral sclerosis
• multiple sclerosis

32. Clinical features
• Foot drop, which refers to an inability to lift
the forefoot due to weakness of the
dorsiflexion muscles in the foot, may be
partial or complete, developing acutely or
over a period of days to weeks.
• Depending on the underlying cause of foot
drop, other symptoms may also be present.

34. Diagnosis
• Extremity imaging (eg, plain radiography or
CT) is useful to evaluate for fractures, masses,
arthritis, or tumor if the history suggests one
of these etiologies.
• Magnetic resonance (MR) imaging of the
lumbar spine, knee, or ankle may be
considered to evaluate for potential soft tissue
lesions .

35. • Electrodiagnostic studies
• EMG and nerve conduction studies (NCS) can
also be helpful in localizing the lesion.
• Motor nerve conduction studies of the
peroneal nerve and tibial nerve and sensory
nerve conduction studies of the sural and
superficial peroneal nerves are recommended.

36. Treatment
• Conservative care — The goal of conservative
management is to stabilize the gait and prevent
"foot slap," as well as to prevent contracture of
the denervated muscles .
• Physical therapy — Physical therapy focuses on
stretching and strengthening both the muscles
affected by the palsy, as well as the opposing
musculature. The initial focus of therapy is to
stretch the contralateral muscle groups .

37. • Splinting — Splints and braces are used in
conjunction with physical therapy to optimize
treatment outcomes. Different types of
footwear and splints are used, depending on
the location of the nerve injury .

38. Surgical treatment
• Nerve repair
• Neurolysis
• Tendon transfer.

39. THANK YOU