"heneymooner's palsy", if your arm paralyzed after your honeymoon...

Wrist drop, "Saturday night palsy"

As you wake up, if you feel weakness of wrist movement, just think about peripheral neuropathies.

Among the series of neuropathies, one of the most common neuropathy is the radial nerve neuropathy, so-called Saturday night palsy. Typically, the individual lies with the upper limb in an awkward position such as over a sharp ledge/back rest of a chair, or rests the head on the lateral surface of the arm. A particular form of radial nerve insult may occur when a person allows another to rest his or her head on the middle third of the arm whle caressing that person. In this instance, the radial and forearm extensor muscles against the shaft of the humerus, the so called heneymooner's palsy.

Arm extensors (triceps brachii) are usually spared. However, for the neural branches to the medial and possibly lateral heads of the triceps muscle to be injured, producing some elbow extension weakness. Weakness of brachioradialis is a particular important sign in radial nerve injuries.

Superficial radial nerve (sensory nerve, cutaneous nerve) can be injured. However, it can be also spared if the lesion is below the point of seperation of superficial radial nerve. (In this case, only motor branch is injured.)

Radial nerve lesions in the arm also produce wrist drop and inability to extend the fingers because of denervation to the extensor carpi radialis longus/brevis and extensor carpi ulnaris, and the extensor digiti communis, extensor indicis proprius, extensordigiti minimi, and extensor pollicis longus/brevis muscles, respectively.

The diagnosis should be performed via electrodiagnostic medicine. With nerve conduction study and electromyography, the examiner can diagnose the exact site of lesion, amount of neural damage, and kinds of involved muscles.

The electrodiagnostic diagnosis should be done at least 3 weeks later from the time symptoms arise. During first 3 weeks, the change of the nerve can't be detected with electrodiagnostic medicine.

(Physical exmaination for radial nerve palsy. In this video, the patient is being requested to extend his wrist and finger, but he can't do that movement. The examiner should fix the patient's forearm to isolate the arm movement. This patient was diagnosed with peripheral neuropathy of radial nerve, at the arm level.)

Treatment of the wrist drop depends on the causes of the disease. If there is no traumatic lesion or bony abnormalities, initial treatment is splinting of the wrist. Medications may include analgesics, anticonvulsant medicines or tricyclic antidepressants to reduce stabbing pain. Also, steroid injection around nerve to reduce swelling may help some patients.

Physical therapy help maintain the range of motion of the wrist and increase the muscle strength. Electrical stimulation of radial nerve, passive movement of wrist joint, and isometric exercise of wrist extenor can be included.