SATURDAY NIGHT PALSY!!

 

Mj Omeiza Ishaq

During a clinical posting in the accident and emergency unit in our teaching hospital as a student, a man was rushed to our A&E unit presenting with inability to raise his left arm or hold anything with it. It is said to have occurred overnight. After a series of clinical investigations, we recorded that the patient had a sleeping hangover which led to the compression of his radial nerve in the arm. Our unit consultant explained that in most cases it occurs as a result of intoxication from alcohol with a sleeping hangover which is presented and termed as Saturday night Palsy.

 

The clinical phrase saturday night paralysis always rings a surprise bell to our ears as students or practitioners and the neurological problem is a global health challenge that needs attention though very rare and could be self limiting. It is reported that this paralysis affects 2.97 per 100,000 men and 1.42 per 100,000 women and It is the fourth most common mononeuropathy in the United States. The prevalence is also similar across other countries.

The terminology "Saturday night paralysis" originates from the association between Saturday night carousing and the intoxication to the stupor that follows, leading to an overtime period of immobilization during which nerve compression can take place while asleep. Most intoxicated individuals do not regain the ability to correct their position while asleep. This immobilization in the unnatural position results in damage to the radial nerve. The radial nerve runs from the upper arm to the wrist and fingers. This nerve supplies the radial muscle controlling movement and sensation in the arm and hand and extension of the elbow, wrist and fingers. Damage to the radial nerve causes weakness,numbness and an inability to control the muscles served by this nerve.

 

Signs and symptoms

1.Patient present with numbness of the triceps muscle down to the fingers.

2. Problems extending the wrist or fingers.

3. Pinching and grasping problems.

4  Inability to control muscles from the triceps down to the fingers.

5. Wrist drop with difficulty lifting it.

 

Differential diagnosis

Other factors that cause compression of the radial nerve present as differentials. This includes trauma, injury and cysts in the radial nerve. Humeral fractures are the most common cause of radial nerve injury.Others are severe blunt trauma and puncture wounds.

 

Treatment

Treatment for Saturday night paralysis is generally focused on physical rehabilitation. Physical therapy involves the use of a soft wrist splint that holds the wrist in extension.Other measures include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), systemic corticosteroids, steroid injections.

Advance measures involve the use of X-rays and CT-scan. Ultrasonography is also used to administer localized injections to speed recovery. Surgical management is reserved for severe injuries of the radial nerve or for cases in which the compression results from an intrinsic process such as a mass  or cyst.

Counseling remains a key in all aspects of health care delivery and as a primary eye care practitioner it is also your duty to advise your patients on their sleeping position and posture and also speak to them to reduce or quit their alcoholic intake as it is also a risk factor to some eye disease like diabetic retinopathy.

 

References:

 

1.Ansari FH,Juergens AL. Saturday night palsy.[Updated 2022 may3].In:startpearls [internet]. Treasure island( FL): statpearls publishing;2022.

2.Chen SR et.al. Ultrasound-guided perineural injection with dextrose for treatment of radial nerve palsy: A case report.Medicine(Baltimore).2018 June.97(2).

3.Moore, K. L., & Dalley, A. F. (1999). Clinically oriented anatomy. Philadelphia: Lippincott Williams & Wilkins.