radial nerve palsy; radial nerve entrapment; wrist drop; Saturday night palsy

Etiology

• injury caused by
  • improper use of crutches
  • fracture of the humerus
  • pressure at the wrists
    • chronic or repetitive constriction of the wrist (wristband)
    • swelling or injury of nearby structures
  • pressure to the upper arm
    • hanging the arm over the back of a chair (Saturday night palsy if alcohol related)
    • arm positions during sleep or coma
• idiopathic Clinica manifestations:
• abnormal sensations
  • back of the hand
  • radial surface of the hand
  • 2nd & 3rd fingers
• difficulty straightening the arm at the elbow
• difficulty with supination of the arm
• difficulty with dorsiflexion at the wrist or wrist drop
• muscular atrophy in the forearm
• paresthesias
• pain

Diagnostic procedures

• electromyogram
• nerve conduction studies
• nerve biopsy (rarely needed)

Radiology

• magnetic resonance imaging (MRI) of the head, neck, & shoulder to look for other causes

Management

• correct underlying etiology or behavior
• surgery to remove masses that compress the radial nerve
• analgesics to control pain
• anticonvulsant medicines may reduce stabbing pain
• glucocorticoid injections around the nerve to reduce swelling may help some patients
• braces, splints, or other appliances map help in severe cases
• physical therapy
• occupational therapy to suggest changes in the home or at the worksite
• prognosis:
  • most cases will fully recover
  • in more severe cases, there may be partial or complete loss of movement or sensation

More general terms

• entrapment neuropathy; nerve entrapment syndrome; pinched nerve

Additional terms

• radial nerve