Clinical, Electrodiagnostic, and Ultrasound Findings in 87 Patients With Finger Drop

Lisa B Shields; Vasudeva G Iyer; Yi Ping Zhang; Christopher B Shields

doi:10.7759/cureus.57913

Clinical, Electrodiagnostic, and Ultrasound Findings in 87 Patients With Finger Drop

Cureus. 2024 Apr 9;16(4):e57913. doi: 10.7759/cureus.57913. eCollection 2024 Apr.

Authors

Lisa B Shields¹, Vasudeva G Iyer², Yi Ping Zhang¹, Christopher B Shields¹

Affiliations

¹ Neurological Surgery, Norton Neuroscience Institute, Norton Healthcare, Louisville, USA.
² Neurology/Clinical Neurophysiology, Neurodiagnostic Center of Louisville, Louisville, USA.

Abstract

Background: The inability to extend the fingers at the metacarpophalangeal and interphalangeal joints leads to finger drop. While wrist drop and foot drop are well recognized, the causes of finger drop are poorly understood.

Aims: This study describes the clinical, electrodiagnostic (EDX), and ultrasound (US) features in patients with finger drop.

Materials and methods: This is a retrospective study of 87 patients presenting with finger drop and referred for EDX studies during the past 10 years. We analyzed the clinical picture, EDX data, and US findings. The patients were categorized into global (all five digits) or partial (limited to 1-4 digits) finger drop.

Results: Fifty-six (64%) patients had global finger drop, while 31 (36%) had partial finger drop. The frequent cause of finger drop was Parsonage-Turner syndrome (PTS) (29 [33%]), followed by trauma (23 [26%]), cervical radiculopathy (16 [18%]), extensor tendon rupture (four [4%]), and compression/entrapment (two [2%]). In 13 (15%) patients, no cause was identified. A total of 13/16 (81%) patients with cervical radiculopathy and four of the patients with tendon rupture had partial finger drop, while 52/64 (81%) with posterior interosseous nerve (PIN) neuropathy had global finger drop. Of the 16 patients who experienced cervical radiculopathy as the cause of the finger drop, 15 patients had C7 and C8 radiculopathy and one patient had C7 radiculopathy. EDX studies of patients with PTS revealed partial axon loss in 18 (62%) patients, conduction block in eight (28%), and total axon loss in four (14%). Enlarged fascicles were observed by US in 40% of patients with PTS. EDX studies of patients who sustained iatrogenic nerve injury causing finger drop demonstrated total axon loss in six (46%) patients, partial axon loss in four (31%), demyelination in two (15%), and conduction block in two (15%).

Conclusions: PIN neuropathy is the most common cause of finger drop, however, lesser-known causes such as cervical radiculopathy and extensor tendon rupture should also be considered. Global finger drop is suggestive of PIN neuropathy, while partial finger drop occurs more often in cervical radiculopathy and tendon rupture. EDX and US studies provide valuable information for localizing the lesion site and may reveal the cause of the finger drop.

Keywords: electrodiagnostic studies; finger drop; neurology; neuromuscular; neurosurgery; parsonage-turner syndrome; posterior interosseous nerve; ultrasound.