Atraumatic Compartment Syndrome Presenting As Wrist Drop: A Case Report

Wrist drop, a common motor deficit seen with radial neuropathy, is typically a result of nerve damage from acute trauma or external compression. Diagnosis is initially suspected by clinical examination, and initial management consists of splinting the wrist, physical therapy, and referral for consideration of outpatient surgical management if it doesn't resolve with conservative measures. While this is commonly managed in the outpatient setting, the emergency physician should keep a broad differential when evaluating patients with wrist drop, as there are rare causes of wrist drop that may require emergent surgical management. In this report, we discuss a case of wrist drop due to compartment syndrome. We present a case of a male in his early 30s who presented to the emergency department (ED) with left upper extremity numbness and weakness noticed upon awakening. Examination revealed tense compartments in the left forearm with associated wrist drop. Laboratory workup revealed rhabdomyolysis with multi-organ failure, and the patient was taken for emergent fasciotomy with orthopedic surgery. This report highlights a case of acute compartment syndrome in a critically ill patient who initially presented to the ED with wrist drop. The case demonstrates the need for emergency physicians and other acute care clinicians to keep a broad differential in patients presenting with acute peripheral neuropathies. This rare cause of radial neuropathy warrants consideration, as prompt recognition, diagnosis, and emergent management of compartment syndrome are needed to prevent life and limb-threatening morbidity and mortality.