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9.19 Radial Neuropathy (Saturday Night Palsy)


Presentation

The patient has injured his upper arm, usually by sleeping with his arm over the back of a chair, and now presents holding the affected hand and wrist with his good hand, complaining of decreased or absent sensation on the radial and dorsal side of his hand and wrist, and of inability to extend his wrist, thumb and finger joints. With the hand supinated (palm up) and the extensors aided by gravity, hand function may appear normal, but when the hand is pronated (palm down) the wrist and hand will drop.

What to do:

What not to do:

Discussion

This neuropathy is produced by compression of the radial nerve as it spirals around the humerus. Most commonly it occurs when a person falls asleep, intoxicated, held up by his arm thrown over the back of a chair. Less severe forms may befall the swain who keeps his arm on his date's chair back for an entire double feature, ignoring the growing pain and paresis. If the injury to the radial nerve is at the elbow or just below, there may be sparing of the wrist radial extensors as well as the radial nerve autonomous sensation. The deficient groups will be the wrist ulnar extensors as well as the metacarpophalyngeal extensors. A high radial palsy in the axilla (e.g., from leaning on crutches) will involve all of the radial nerve innervations, including the triceps.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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