İzole Distal Üst Ekstremite Ekstansör Güçsüzlük Nedeniyle Yönlendirilen Hastaların Değerlendirilmesi: Retrospektif Elektrofizyolojik Çalışma

Öz

Bu çalışma, izole distal üst ekstremite ekstansör güçsüzlüğü bulunan hastaların klinik ve elektrofizyolojik özelliklerini inceleyerek etiyolojileri ve periferik sinir tutulumunun anatomik seviyelerini açıklamayı amaçlamaktadır. 2007–2025 yılları arasında el bileği veya parmak düşüklüğü ile başvuran 57 hasta retrospektif olarak değerlendirildi. Tüm hastalara median, ulnar ve radial sinirlerin motor ve duyu ileti çalışmaları ile birlikte radial sinir ve C7–C8 kökleri tarafından innerve edilen kasların iğne elektromiyografisi (EMG) uygulandı. Radial sinir lezyonları üç düzeyde sınıflandırıldı: Düzey 1 (triseps dalının proksimali), Düzey 2 (triseps sonrası ve supinator öncesi), Düzey 3 (posterior interosseöz sinir). Sinir hasarı aksonal veya demiyelinizan olarak kategorize edildi. 40’ı erkek, 17’si kadın olmak üzere toplam 57 hastanın 56’sında radial sinir hasarı saptandı. En sık neden travma olup, bunu cerrahi ve kompresyona bağlı yaralanmalar izledi. Elektrofizyolojik bulgular, en sık tutulumun distal humerus ile ilişkili olan Düzey 2’de görüldüğünü ortaya koydu. Düzey 1 yaralanmaları proksimal humeral lezyonlarla, Düzey 3 ise radius cismi ile ilişkili lezyonlarında sık izlendi. Tüm hastalarda aksonal hasar saptanmakla birlikte, olguların %49 unda kısmi, %28 inde total ve %23 belirgin kısmi aksonal hasar mevcuttu. Bulgularımız, travmaya bağlı radial sinir yaralanması izole distal ekstansör güçsüzlüğünün en önemli nedeni olduğunu göstermektedir. Lezyonların doğru lokalizasyonu, tanının kesinleştirilmesi ve uygun tedavi stratejilerinin belirlenmesi açısından elektrofizyolojik değerlendirme gereklidir

Anahtar Kelimeler

• Düşük el
• düşük parmak
• travmatik radial sinir hasarı
• elektromyografi

Evaluation of Patients Referred for Isolated Distal Upper Limb Extensor Weakness: A Retrospective Electrophysiological Study

Öz

This study investigated the clinical and electrophysiological features of patients with isolated distal upper extremity extensor weakness, focusing on etiologies and anatomical levels of peripheral nerve involvement. A retrospective review included 57 patients evaluated between 2007 and 2025 with wrist or finger drop. All underwent motor and sensory conduction studies of the median, ulnar, and radial nerves, as well as needle EMG of radial nerve–innervated muscles and C7–C8 roots. Radial nerve lesions were classified into three levels: Level 1 (proximal to the triceps branch), Level 2 (distal to triceps and proximal to supinator branches), and Level 3 (posterior interosseous nerve). Nerve injuries were categorized as axonal or demyelinating. Of the 57 patients (40 men, 17 women), 56 had confirmed radial nerve injury. Trauma was the leading cause, followed by surgical and compression-related injuries. Electrophysiologically, Level 2 was the most frequent site, typically corresponding to distal humeral injuries. Level 1 injuries were associated with proximal humeral lesions, while Level 3 was linked to radial shaft involvement. All patients showed axonal damage: 49% partial, 28% total, and 23% prominent partial. Our results show that trauma-related radial nerve injury is the predominant cause of isolated distal extensor weakness. Electrophysiological evaluation is essential for accurate localization, diagnosis, and management.

Anahtar Kelimeler

• Wrist drop
• finger drop
• traumatic radial nerve injury
• electromyography

Kaynakça

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