Session Time: None. Available on demand.
Disclosures: Katherine Chen, DO: No financial relationships or conflicts of interest
Case Diagnosis: A 36-year-old female with liver cirrhosis presented with left wrist drop.
Case Description: The patient initially presented to the hospital due to decompensated liver cirrhosis and alcohol withdrawal. On admission, left arm ecchymosis and edema was noted, but no gross neurological deficits. There was a questionable history of a fall prior to admission, but no trauma during hospitalization. On day 8, the patient had severe pain and worsening swelling of her left arm. Left upper extremity ultrasound showed hematomas at the left shoulder and elbow. No fractures were seen on X-ray. Orthopedics recommended no hematoma evacuation due to coagulopathy. Pain medication was given and the patient was eventually discharged. In outpatient PM&R follow-up, she was found to have a demyelinating lesion of the left radial nerve and axonal loss on electromyography 6 weeks post-injury. Muscle strength of wrist and finger extension was 1/5. A radial nerve block was performed for pain. She was prescribed a dynamic wrist orthosis and attended outpatient occupational therapy. MRI 8 weeks post-injury showed mild enlargement of the radial nerve at the level of the midhumerus with associated denervation edema. The patient reported significant improvement in pain and function at that time.
Setting: Outpatient PM&R clinicAssessment/
Results: Imaging studies performed initially correlated clinically with a hematoma in the distal humerus compressing on the radial nerve, causing left wrist drop. Radial nerve involvement was further confirmed with EMG and MRI. At 8 weeks post-injury, the patient reported improvement in pain and function of the left wrist, showing signs of motor recovery.
Discussion: The patient’s arm pain and edema prompted further investigation into wrist drop. In the setting of negative x-rays for humerus fractures and thrombocytopenia, soft tissue compression of the radial nerve is possible.
Conclusion: In the absence of humerus fractures, soft tissue compression causing radial nerve palsy should be considered.
Level of Evidence: Level V
To cite this abstract in AMA style:Chen K, Lam J, Okada J, Chen CK. Radial Nerve Palsy Due to Humeral Hematoma: A Case Report [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/radial-nerve-palsy-due-to-humeral-hematoma-a-case-report/. Accessed September 24, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/radial-nerve-palsy-due-to-humeral-hematoma-a-case-report/