Drop hand in severely disabled sister
November 10, 2010 | 15,00 EUR | answered by Dr. med. Olaf Stephan
Hello,
my severely mentally and physically disabled sister has had a condition called a dropped hand for about 3 weeks now, meaning her hand is completely limp. She normally wears a support brace due to her severe scoliosis. It is likely that a nerve has been pinched. My question is, what can be done to reactivate the nerve. Our treating doctor is quite relaxed about it and believes that it will likely resolve on its own. However, as my sister is very limited (blind, unable to walk, cannot take care of herself, cannot express herself properly (only partially feel pain)...), any additional loss is a huge disaster. Additionally, neurological examinations are practically impossible (she won't allow anything to be done to her). Is it possible to massage the hand (sometimes it is warm, sometimes ice cold), do manual therapy, acupuncture, or something similar? What options are available?
Thank you for your response,
Julia
Dear inquirer,
The cause of radial nerve palsy is a paralysis of the radial nerve (which supplies a portion of the muscles of the arm and hand). Since this nerve is quite long, the affected points can be located along a stretch from the armpit to the hand. Based on your description (assuming it is a pure radial nerve palsy), the lesion is likely localized in the area of the forearm. In many cases, pressure or positioning damage to the nerve is the cause of temporary paralysis, sometimes fractures or trauma can also be the cause, so the corset may not necessarily be the cause. Since a nerve physiological examination is apparently not possible for your sister, I would first assume that the damage to the nerve is due to pressure or positioning (which appears to be the most likely cause here), with the nerve generally remaining intact and the paralysis gradually improving over a longer period of time (weeks or months), so a lot of patience is required. Since the thermoregulation of the hand or arm is also affected, the hand may feel cold or warm at times. Therapeutically, there are not many options to speed up the nerve recovery process, especially since many things may be difficult to achieve in your sister's case. It is important and likely feasible in your case to perform daily passive and active exercises for the fingers and hand, which can also help determine if the nerve has already started to recover. Furthermore, the extremity should always be kept warm, which is also comfortable for the patient. If feasible, supportive electrotherapy (through an outpatient physiotherapist) can be done 2 to 3 times a week, and pain medication can be given for pain or discomfort. The oral administration of B vitamins is controversial and does not seem to significantly speed up the healing process. In rare cases, the paralysis may persist, but since specific examinations are currently not possible, the prognosis cannot be accurately predicted, so I would advise you to be patient at this point.
Best regards, O. Stephan.
