Finger Drop: Cervical Radiculopathy, Peripheral Nerve Lesion, or Multifocal Neuropathy? A Case Report

Abstract

Background Posterior interosseous nerve (PIN) lesions can result in finger drop. Multifocal neuropathy (MFN) occurs when a primary nerve disorder predisposes the nerve to further injury. Case Presentation A 69-year-old male presented with left-handed weakness and left-sided pain of the neck, upper trapezius, and medial scapular border 4 weeks after an asymptomatic fall. Findings regarding proximal pain were consistent with cervical radiculopathy (CR). Distal weakness indicated a PIN lesion: spared sensation/supination, limited finger extension, and radial deviation upon wrist extension. MFN was considered based on history/presentation. The care team included a physical therapist, a neurosurgeon, and a hand therapist. Outcome and Follow-up Resolution of CR pain occurred at 1 month; finger extension/grip strength improved at 3 months but was less than anticipated. Discussion With neurogenic weakness, one needs to consider central- and peripheral-mediated origins, MFN contributions, and appropriate referrals. JOSPT Cases 2022;2(2):112–116. doi:10.2519/josptcases.2022.10601