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Mar 26 2012

Pique the Geek 20120325. Wrist Drop

I apologize for not keeping up with my normal posts, but I have developed a rather serious neurological disorder, the common name being wrist drop.  It has to do with damage to the nerve that serves to flex, in my case, the right wrist and fingers.

It also has a minor sensory component in that the dorsal surface of my thumb and surrounding part of my hand feels pressure poorly but is fully responsive to heat and cold.  It happened literally overnight, as when I awoke Monday morning my hand was fully involved.

I am much improved now, and thought that I should share some of my findings with you.  I also plan to resume My Little Town and Popular Culture next week.

The cause of wrist drop is damage to the radial nerve.  This can be caused by a number of events, the most serious one being the nerve being severed, usually by a dislocation fracture of the humerus.  In those cases, microsurgery to attempt to reconnect the severed ends of the nerve is the only treatment with any hope of success.

More common, and fortunately usually less severe cases, are caused by compression injury and/or ischemia (lack of blood supply) to the nerve from abnormal pressure.  Indeed, one name for this condition is called Saturday night palsy because one common, classical scenario is a person becoming intoxicated and having their humerus compress against the nerve and/or blood supply, usually by a sharp arm of a chair.

Another name for the condition is Honeymoon wrist.  This is caused by one sexual partner resting her or his head on the upper arm of the other partner during the blissful sleep that follows the most physical expression of love.

Yet another cause is the improper use of crutches.  This can be more serious because it is higher up the arm and can cause elbow involvement as well.  Sometimes this is called Crutch wrist or Crutch elbow.

The radial nerve also seems to be unusually sensitive to the neural toxin lead, and wrist drop is sort of diagnostic of lead poisoning.  Blood tests can be done to determine if abnormally high levels of lead are present in those cases.

I have a new name for the condition.  It is Blogger’s wrist.  I acquired it from answering comments until it was very late, and just wanted to put down my head for a few minutes.  My computer table is a century old solid oak librarians’ table, and it has sharp edges.  The other night, I put my right arm down to pad my head, but went to sleep.  That did the trick.

Fortunately, the area was under compression for only a few hours.  My symptoms are slowly (too slowly for my liking) abating, and I expect to have a full recovery.  I have splinted the wrist to keep it from remaining in the flaccid position, and am taking about double the recommended amount of aspirin as an anti inflammatory.  Fortunately, I tolerate aspirin quite well.  For those who do not, ibuprofen or naproxin are sensible choices.  Since acetaminophen is not only a poison and NOT an anti inflammatory, it is useless.

I can fully extend all of my fingers now, and partially extend my thumb.  That is from the knuckle down, and can partially extend my index finger from the wrist.  That is a lot more than I could do yesterday, so I am recovering.  Thanks the the wealth of information available on the tubes and from my good friend, the best pharmacist that breathes, I am on the mend.  But my case was fairly minor.

My very good friend from high school was not so fortunate.  Jody, and I shall use only her nickname because she has a wonderful daughter who is also a Facebook friend with me, was bad into heavy drugs.  She overdosed, passing out on her arm, and was not found for days.  She lived, but the damage was irreversible.  Until the day that she died (and I am not sure that she did, perhaps in the witness protection program), her wrist dropped.  That was several years.

I have just noticed a very subtle interplay on the keyboard with my fully functional left hand and partially disabled right one.  The nerve impulses are out of sync, and I seem to make more left handed mistakes that right handed ones.  That is just a recent observation.  I tend to think that is has to do with me looking at where my right index finger is, and trust my left to touch.

This has been a very illuminating experience.  First and foremost, I have a new and deeper empathy for disabled persons.  Although hardly disabled as really disabled folks, I did get a taste of that bitter cup of wine.  Mundane things like showering became difficult.  Feeding The Girl’s Girl was nearly impossible.  Buttoning 501 Levis was impossible (fortunately I have a couple of 505s).  This happened to my dominant hand (around 80% of cases do), so I have had to use my left hand for many more things this last week.

Writing has been out of the question.  That is back now since I can extend my fingers.  I still have to use my left hand for the mouse because of the dead weight that my right hand puts on that unit.  The same goes for the keyboard.  I can use my left hand fine, but only my index finger for the right side.  I can keep it well above the keyboard using my elbow and just strike with it when needed, about half of the time.  Obviously, it will take me a bit longer to respond to comments than usual.  I sincerely hope that there are not too many typographical errors on account of that.

Little things like using toilet paper are impossible, except for doing it left handed.  To see how that works, try a couple of times using your nondominant hand for that.  It is a whole new world, and not a good one.  Shaving left handed was also a problem, as I sort of ripped myself to shreds, even with a brand new blade.

Here is my progression from the right hand being essentially a useless collection of tissue Monday to now.  From no extension ability at all from my wrist down Monday, I can extend all but my ring finger, and my thumb a bit.  I have a LITTLE ability to extend my index and middle fingers from the wrist now (written at 9:39 PM Eastern, Saturday).  The sensory feelings are recovering in all areas, but is incomplete as of now.

Many of you will call me an idiot for not going to the emergency department at the nearest hospital, and I shall not criticize you for that.  Most of you know that I smoke tobacco, and that is a prime causal factor for a stroke, and those can have similar symptoms.  I did a self diagnosis when this was first manifested and ruled stroke out immediately.

Using my left hand, I palpated all of the right side of my body.  Except from the wrist down, there was no sensory defect.  Then I used a flashlight to examine my pupils.  They were both the same under ambient light, and each contracted to the same degree under illumination.  Then I flexed and extended all voluntary muscle control on both sides of my body, and except from the right wrist down, they were identical.

Obviously I did not have a stroke, or many other systems would have been involved.  That told me that it was local.  Except for occupational therapy, splinting and anti inflammatories are about it.

Other than possible physical therapy, there is not much that can be done with condition other than splinting and the anti inflammatory drugs.  I have put off mowing the lawn (that needs it BADLY!) for fear of making is worse, but it has to be done tomorrow.

At 11:00 PM Eastern, three more aspirin and then to bed.  I hope to see as much recovery betwixt last night and this morning as I saw yesterday.

Back again, now 5:00 PM on Sunday.  VH1CL is playing Live at the Isle of Wight by The Who from 1970.  Some critics say that this may be their finest performance.  Nice background for writing, and a nice interlude after a wonderful earlier part of the day.  I did get my front yard mowed and decided that I had better put the splint back on my arm.  I shall do the back tomorrow.

I could not help it; I had to watch the show.  Since there was no Popular Culture Friday, here is a snippet from it:

The first is a wonderful Entwistle song called “Heaven and Hell” and the second is “Pinball Wizard”.  I had to include it because of the “…such a supple wrist.” part.

I continue to improve slowly, and expect a full recovery.  I shall keep you posted over the next couple of weeks about my progress.

Well, you have done it again!  You have wasted many more einsteins of perfectly good photons reading this limp topic.  And even though Newt Gingrich STILL realizes that he will NEVER be President when he reads me say it, I always learn much more than I could possibly hope to teach in writing this series, so keep those questions, comments, corrections, and other feedback coming.

I shall stick around as long as comments warrant tonight and shall return tomorrow around 9:00 for Review Time.  Remember, no science or technology issue is off topic here.

Warmest regards,

Doc, aka Dr. David W. Smith

Crossposted at

Daily Kos,

Docudharma, and

firefly-dreaming

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