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Drummer Palsy – Causes, Symptoms and Treatment

Drummer palsy is a compression injury of the radial nerve caused by prolonged pressure on the upper arm. It typically presents as wrist drop and numbness on the back of the hand.

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Things worth knowing about "Drummer Palsy"

Drummer palsy is a compression injury of the radial nerve caused by prolonged pressure on the upper arm. It typically presents as wrist drop and numbness on the back of the hand.

What is Drummer Palsy?

Drummer palsy is a type of peripheral nerve palsy caused by sustained or repeated pressure on the radial nerve in the region of the upper arm. The radial nerve is one of the main nerves of the arm and is responsible for supplying the extensor muscles of the forearm, wrist, and fingers. When this nerve is compressed against the humerus (upper arm bone) for an extended period, it can lead to a temporary or, in rare cases, permanent loss of nerve function.

The term drummer palsy has historical origins: military drummers who played their instruments in a position that placed prolonged pressure on the upper arm were frequently observed to develop this condition.

Causes

The most common cause of drummer palsy is sustained compression of the radial nerve in the radial groove (sulcus nervi radialis) of the humerus. Typical causes include:

Falling asleep with the arm draped over a chair back or bed edge (Saturday night palsy)
Prolonged leaning of the upper arm on a hard surface
Tight bandages or casts around the upper arm
Use of crutches (so-called crutch palsy)
Fractures of the humerus
Surgical procedures with unfavorable arm positioning under general anesthesia
Heavy alcohol or sedative use leading to a deep sleep without position changes

Symptoms

The hallmark symptom of drummer palsy is wrist drop: the affected person is unable to actively extend the wrist and fingers, because the extensor muscles supplied by the radial nerve are paralyzed. Other typical symptoms include:

Weakness or complete paralysis of finger and wrist extension
Numbness or tingling (paresthesia) on the back of the hand and over the first three fingers (thumb, index finger, middle finger)
Pain in the upper arm or shoulder region (depending on the cause)
Reduced gripping ability of the hand

Flexion of the hand is typically preserved, as the flexor muscles are supplied by the median and ulnar nerves, which are not affected.

Diagnosis

The diagnosis of drummer palsy is primarily clinical, based on a targeted neurological examination:

Neurological examination: Assessment of motor strength (wrist and finger extension) and sensory function (touch and pain sensation on the back of the hand)
Electromyography (EMG): Measurement of electrical muscle activity to assess the extent of nerve damage
Electroneurography (ENG): Measurement of nerve conduction velocity to localize the lesion and determine its severity
Imaging: If a structural cause is suspected (e.g., fracture, tumor), X-rays or MRI of the arm may be performed

Treatment

Treatment of drummer palsy depends on the cause and the severity of the nerve injury. In most cases, the damage is a temporary compression injury (neurapraxia), which recovers spontaneously once the compressive force is removed.

Conservative Treatment

Decompression: Immediate removal of the pressure source
Orthotic devices: Splints or wrist orthoses to hold the hand in an extended position and prevent deformity
Physiotherapy: Targeted exercises to maintain muscle function, prevent atrophy, and support nerve regeneration
Electrotherapy: Electrical stimulation of the paralyzed muscles to maintain muscle mass during the recovery period

Surgical Treatment

Surgery is rarely required and is reserved for cases where there is confirmed structural disruption of the nerve (axonotmesis or neurotmesis), when recovery does not occur after several months of conservative therapy, or when a structural cause (e.g., bone fragments from a fracture) is present. Surgical options include neurolysis (freeing the nerve from scar tissue), nerve suturing, or nerve grafting.

Prognosis

For pure compression injuries (neurapraxia), the prognosis is generally excellent. Recovery typically begins within a few weeks to three months. In cases of more severe nerve damage, recovery may take six to twelve months or longer. Full recovery is possible in the majority of cases, provided the underlying cause is addressed in a timely manner.

References

Mumenthaler, M.; Stöhr, M.; Müller-Vahl, H.: Peripheral Nerve Injuries and Radicular Syndromes. Georg Thieme Verlag, Stuttgart, 10th edition, 2014.
Spinner, R.J.; Shin, A.Y.: Nerve entrapment syndromes of the upper extremity. In: Green's Operative Hand Surgery, 7th edition, Elsevier, 2017.
Latinovic, R.; Gulliford, M.C.; Hughes, R.A.: Incidence of common compressive neuropathies in primary care. Journal of Neurology, Neurosurgery and Psychiatry, 2006; 77(2):263-265.

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