Saturday Night Palsy or Going Easy On Your Nerves

By: David Ravech

You may be familiar with the picture, either personally or from a story somebody told you. A young man goes out for the evening, all dressed up and smelling of aftershave. He meets his mates in the pub and has a few beers, starting off the process of intoxication which continues most of the night. After the pub there is the nightclub and more drinking until it's time to roll out and round to the kebab house to have a snack. After a bit more hanging about he goes home or to one of his mates' houses to watch television, chat and perhaps drink a little more.

He's going to have a hangover in the morning but there is no surprise there and he certainly won't be. The thing he doesn't expect is falling asleep for some time in the odd position he last happened to adopt whilst watching the TV. He's sitting sideways on a chair and has draped his arm over the back of the chair and that's how he has fallen asleep. Some hours later he wakes up and finds himself in the same position. The arm is numb but he shakes it about and rubs it to get it back to life like we often have to when we lie on our arm at night.

If we adopt an odd or stressful position when we sleep the increasing discomfort in the part wakes us up or we naturally just move to a better posture. When we are drunk however we may not do this and this was the problem which allowed the bodily structures in his armpit to suffer significantly increased stresses for perhaps some hours before he finally woke. The arm will hardly move at all and he becomes concerned when it does not respond to shaking and rubbing by recovering its movement.

Nervous tissue is designed to react to stimuli but give them too much input for too long and there will be a negative reaction in terms of nerve function. Direct blows or pressure for a significant length of time are both potential hazards, for example by one member of couple using their partner's arm as a pillow to sleep, the resulting nerve problem being called honeymooners' palsy. Continual pressure on a nerve can interrupt the blood supply and damage nerve function in a condition known as neurapraxia.

Nerve damage is classified into three categories: axonotmesis, neurotmesis and neurapraxia. Neurapraxia is the mildest variety of nerve trauma and there is internal biochemical damage to the nerve but no break in the internal axon or the nerve itself. The nerve being intact, it does not need to regenerate but recover. Nerve impulse conduction is disrupted by the area of nerve trauma and gives paralysis of the muscle with some difference in feeling. Compression may cause avascular damage to the nerve, resulting in inflammatory changes.

The paralysis which leads to loss of function of the arm is temporary and can resolve in hours. However, in even average cases it can be six to eight weeks before the slow improvement occurs and normal strength returns to the arm. There is mostly a greater interruption of muscle power with feeling and sweating/circulation control of the arm less affected. As this can be serious the person should be examined by a doctor, for although there may be little to be done but wait, the sufferer needs to have the problem explained and be instructed how to look after their arm until it recovers.

Since the arm is paralysed to a greater or lesser degree a sling may be needed for shoulder support and to keep the arm out of the way. If there is loss of feeling the person needs to check carefully what they are doing with the arm and examine it regularly for signs of damage. Vigilance is important as the arm can be damaged without being aware of it. Nerve trauma like this can also occur in sporting activities or long term pressure events such as falling asleep on a toilet.

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Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Winchester physiotherapy visit his website.

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