What is Saturday night palsy?

Saturday night palsy is a compressive neuropathy of the radial nerve that occurs from prolonged, direct pressure onto the upper medial arm or axilla by an object or surface.

Saturday night palsy has become synonymous with radial nerve compression in the arm resulting from direct pressure against a firm object.

Origin of prase

It typically follows deep sleep on the arm, often after alcohol intoxication. The commonly accepted origin of the phrase is the association of Saturday night with carousing.

Radial nerve

The radial nerve is composed of the C5 to T1 nerve roots, which arise from the posterior segment of the brachial nerve plexus. It initially runs deep to the axillary artery before passing inferior to the teres minor and then wrapping down the medial aspect of the humerus, where it lies in the spiral groove.

Causes for Saturday night palsy

• Saturday night palsy has in other instances been referred to as "honeymoon palsy". Both names suggest a scenario where immobilization in an unnatural position can result in prolonged compressive damage onto the radial nerve.

• Intoxicated individuals may not retain the reflexive ability to correct their position while asleep.

• Saturday night palsy classically involves an individual falling asleep with the arm hanging over a chair or other hard surface, leading to compression within the axilla.

• Honeymoon palsy, on the other hand, refers to an individual falling asleep on the arm of another and consequently compressing that person's nerve.

• Any unnatural positioning or use of the limbs can cause compression by a similar mechanism.

• Compressive clothing or accessories.

• Improper use of crutches.

• Blood pressure cuff usage.

Signs and Symptoms

Patients will often report symptom onset after consuming a large amount of alcohol and then sleeping in an unnatural position.

Symptoms can also begin several days after the initial insult, leading to a delayed presentation.

• Patients may report numbness from the triceps muscle.

• Burning pain or any combination of these.

• Wrist drop, which results from the loss of extensor muscle function controlled by the radial nerve branches and preservation of the flexor muscles controlled by other nerves in the hand and arm.

• Difficulty with opening hand and grasping objects due to Inability in extending thumb.

• Sensory deficits in the posterior or lateral upper arm.

Complications

Complications can arise from the failure to consider a wide differential diagnosis, which can lead to missing severe disease or illness. It is important to determine the etiology of the radial nerve deficits, as management can change drastically from case to case. In the case of a true compressive Saturday night palsy, the main complication arises from the failure of recovery, which can be an indication for surgical exploration. Surgical options then include nerve grafting, nerve transfers, tendon or muscle transfers, and numerous other described techniques. As with most surgical procedures, there can be a wide set of additional complications related to intraoperative issues and post-surgical infections. Additionally, partial recovery is often achieved in these cases, and long-term disability can be a challenge.

Ways to Prevent from Saturday night palsy

• You can prevent most radial nerve injuries if you avoid putting prolonged pressure on your upper arm.

• Avoid behaviors that can lead to nerve damage, such as repetitive motions or remaining in cramped positions while sitting or sleeping.

• If you work in an occupation that requires repetitive motions, take steps to protect yourself by taking breaks and switching between tasks that require different movements.

• Avoid tight compressive clothing if possible.

Treatment

• Treatment for Saturday night palsy is largely focused on physical rehabilitation.

• Medications also help with treating Saturday night palsy.

The sooner you seek treatment, the better it is for your nerve palsy recovery. If you don't treat your nerve palsy in a timely manner, secondary complications can occur, such as joint rigidity.

W. Thilini Oshadi

References

Spinner, R.J., Poliakoff, M.B. and Tiel, R.L. (2002).The Origin of “Saturday Night Palsy”?. Neurosurgery, 51(3), 737-741.

Ansari, F.H.and Juergens, A.L. (2020). Saturday night palsy. StatPearls.

https://www.healthline.com/health/radial-nerve-dysfunction