A patient can’t extend his wrist after he has met with an accident. He has no sensory loss. Level at which the affected nerve is injured?
**Core Concept:** Nerve injury in the context of peripheral nerves and their functions. Peripheral nerves are responsible for both motor and sensory functions, where motor nerves are involved in muscle movement and sensory nerves are responsible for transmitting sensory information to the central nervous system. The patient's symptoms of loss of wrist extension without sensory loss suggest an injury involving only motor nerves.
**Why the Correct Answer is Right:** When a peripheral nerve is injured, it can affect either motor or sensory function but not both at the same time in the same extremity, as they are separate and independent pathways. In this case, the patient is experiencing loss of wrist extension, indicating a motor nerve injury specifically affecting the motor function of the injured nerve.
**Why Each Wrong Option is Incorrect:**
A. Sensory loss: The absence of sensory loss in the patient's symptoms supports the correct answer, as it excludes a general sensory nerve injury.
B. Upper limb injury: Although an injury in the upper limb is possible, the absence of sensory loss narrows the possibilities to motor nerve injuries specifically affecting the wrist extension function.
C. Lower limb injury: This option is irrelevant as the patient's symptoms occur in the upper limb, not the lower limb.
D. Neck injury: While a neck injury could lead to wrist extension problems, the absence of sensory loss narrows the possibilities to motor nerve injuries specifically affecting the wrist extension function.
**Clinical Pearl:** In the context of peripheral nerve injuries, it is essential to consider both sensory and motor functions when evaluating a patient's symptoms. This principle helps narrow down the possibilities and guide further diagnostic and treatment steps.
**Correct Answer:** D. Neck injury
Explanation: Given the patient's complaint of wrist extension weakness without sensory disturbance, the injury is most likely to be in the upper limb, specifically affecting the motor function of the wrist extension. The correct answer (D) refers to a neck injury, which could potentially cause such symptoms due to the involvement of nerves originating from the cervical spinal cord and traversing the neck region. In this scenario, the injury is most likely to be in the neck, affecting the nerves responsible for wrist extension.