Clinical Reasoning: A 65-Year-Old Woman With Cancer History and Wrist Drop. 2022

Rebecca Merrill, and Meaghan Puckett, and William Patrick Morrow, and Eric D Hsi, and Jason Powell, and Zhongyu Li, and Rakhee Vaidya, and Roy Strowd
From the Wake Forest School of Medicine (R.M., M.P.); and Departments of Pathology (W.P.M., E.D.H.), Radiology (J.P.), Orthopedic Surgery (Z.L.), Hematology and Oncology (R.V.), Neurology (R.S.), Wake Forest Baptist Health, Winston-Salem, NC. rstrowd@wakehealth.edu.

Wrist drop is a common presentation in neurology. To localize the lesion, clinicians can focus on testing finger extension, elbow flexion with semipronated forearm, and elbow extension among other muscle groups and identifying dermatomes of numbness. Once the lesion is localized, electrophysiology or imaging can guide to an underlying etiology. Here, we describe a case that illustrates the importance of using a stepwise approach to diagnose the etiology of wrist drop in a patient with a cancer history. A 65-year-old woman with diffuse large B-cell lymphoma in remission presented with new onset wrist drop, severe pain, numbness, and tingling concerning for peripheral nerve injury. Imaging findings from PET, venous ultrasound, nerve conduction velocity study, and MRI were conflicting favoring deep venous thrombosis, cancer recurrence, or peripheral nerve sheath tumor. A biopsy was ultimately required to confirm the diagnosis.

UI MeSH Term Description Entries
D006987 Hypesthesia Absent or reduced sensitivity to cutaneous stimulation. Hypesthesia, Tactile,Hypesthesia, Thermal,Hypoesthesia,Numbness,Impaired Sensation,Reduced Sensation,Hypesthesias,Hypesthesias, Tactile,Hypesthesias, Thermal,Hypoesthesias,Impaired Sensations,Reduced Sensations,Sensation, Impaired,Sensation, Reduced,Sensations, Impaired,Sensations, Reduced,Tactile Hypesthesia,Tactile Hypesthesias,Thermal Hypesthesia,Thermal Hypesthesias
D009364 Neoplasm Recurrence, Local The local recurrence of a neoplasm following treatment. It arises from microscopic cells of the original neoplasm that have escaped therapeutic intervention and later become clinically visible at the original site. Local Neoplasm Recurrence,Local Neoplasm Recurrences,Locoregional Neoplasm Recurrence,Neoplasm Recurrence, Locoregional,Neoplasm Recurrences, Local,Recurrence, Local Neoplasm,Recurrence, Locoregional Neoplasm,Recurrences, Local Neoplasm,Locoregional Neoplasm Recurrences,Neoplasm Recurrences, Locoregional,Recurrences, Locoregional Neoplasm
D004550 Elbow Region of the body immediately surrounding and including the ELBOW JOINT.
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000086723 Clinical Reasoning Process by which clinicians collect signs and process information to understand the patient's medical situation or problem, and then plan and implement appropriate medical interventions. Clinical Judgement,Clinical Judgements,Judgement, Clinical,Judgements, Clinical,Reasoning, Clinical
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D014953 Wrist The region of the upper limb between the metacarpus and the FOREARM. Wrists
D020425 Radial Neuropathy Disease involving the RADIAL NERVE. Clinical features include weakness of elbow extension, elbow flexion, supination of the forearm, wrist and finger extension, and thumb abduction. Sensation may be impaired over regions of the dorsal forearm. Common sites of compression or traumatic injury include the AXILLA and radial groove of the HUMERUS. Crutch Palsy,Saturday Night Palsy,Cheiralgia Paresthetica,Crutch Paralysis,Lesion, Superficial Radial Nerve,Posterior Interosseous Nerve Syndrome,Radial Mononeuropathy,Radial Nerve Compression,Radial Nerve Diseases,Radial Nerve Entrapment,Radial Nerve Palsy,Radial Palsy,Radial Tunnel Syndrome,Superficial Radial Nerve Lesion,Supinator Syndrome,Wartenberg Syndrome,Wrist-Drop,Cheiralgia Parestheticas,Compression, Radial Nerve,Crutch Palsies,Crutch Paralyses,Entrapment, Radial Nerve,Mononeuropathy, Radial,Nerve Compression, Radial,Nerve Entrapment, Radial,Neuropathy, Radial,Night Palsies, Saturday,Night Palsy, Saturday,Palsies, Saturday Night,Palsy, Crutch,Palsy, Radial,Palsy, Radial Nerve,Palsy, Saturday Night,Paralysis, Crutch,Paresthetica, Cheiralgia,Radial Mononeuropathies,Radial Nerve Compressions,Radial Nerve Disease,Radial Nerve Entrapments,Radial Nerve Palsies,Radial Neuropathies,Radial Palsies,Radial Tunnel Syndromes,Saturday Night Palsies,Supinator Syndromes,Syndrome, Supinator,Tunnel Syndrome, Radial,Wrist Drop

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