a29 yr old Male patient presented with history of polio to right

Question

a29 yr old Male patient presented with history of polio to right upper limb since 9month age, now presented with wrist drop of 1month duration and not able to do activities with left hand MRI and pictures attached what's the diagnosis in left hand ,p patient is known alcoholic.

Riju N · Answer

MRI is normal 
Wrist drop not related to polio of recent onset in an alcoholic is a classic description of a Saturday night palsy where the inebriated patient sleep with radial nerve in radial groove getting compressed overnight 
It is usually a neuropraxia and recover in 6 weeks .
Give a cock up splint to prevent flexion contracture 
Since it is not recovered yet,Watch for another month. 
Meanwhile give physiotherapy in the form of passive stretching and electrical nerve stimulation to prevent muscle atrophy. 
His deltoid is gone. 
Do a muscle charting 
Can consider tendon transfers for polio based on available muscles to improve function 
Remember a muscle loose one grade power after transfer. 
Of the trapezious is good power consider shoulder arthrodesis if deltoid is paralysed.

Manorama Rajan · Answer

Old case of rt upper limb post polioparalysis. Left wrist drop alone is nothing to do with old polio.Pt is a known alcoholic. Ethanol related isolated LT radial nerve palsy. Suggest physio . NCV upper limb  to confirm .

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