“Saturday Night Palsy”- A Short Story

Taking One For the Bottle.

He had gone to bed whole, he said , only to wake up few minutes prior to meet an “alienated” hand who had simply refused to take commands from the rest of his body any longer. Dude could no longer lift his hand at the wrist, and furthermore no longer feel sensations at the back of his hand. In simple terms, he was paralysed from the wrist down to the fingers[ a condition known as Wrist Drop]. It must have been that dream he had that night, in which that woman from the village was chasing him!

I marvelled at the “beauty” of the pathology,eyes glittering with interest [pardon my sick, twisted mind]. I’m sure he must have thought me psycho, but fact was that he was presenting exactly with the features of some form of Radial Palsy [a Mononeuropathy,I.e dysfunction of a single nerve] we had read in Last’s Anatomy those early years in neuro Anatomy and since then have never had the “opportunity” of coming across a real case scenario. Yeah once in a while you see even aged Professors turn into enthusiastic Toddlers visiting Disney Land for the 1st time, when they see a relatively “rare” case.

There was no history suggestive of neck or shoulder region injury, so the Brachial plexus[a network of nerves that is more like the “tree” that gives rise to “branches” of nerves, of which the Radial Nerve is just one] itself was apparently intact. Nil history of arm trauma, arm deformity or pain . So mid shaft fracture of the humerus was unlikely.

I started explaining to him that he had some form of nerve injury, a Neurapraxia [transient loss of nerve function] so to say; that there was this long nerve, the Radial Nerve, that went behind his arm, coiling itself in a spiral fashion around the bone like a snake ’round a tree branch,which among other things was in charge of him bending his hand upwards at his wrist; that most likely he slept carelessly in such a way that there was direct pressure on the nerve with resultant injury leading to the paralysis he was experiencing.

I went on to explain that it happens mostly to drunks who after a binge falls asleep carelessly on a chair with their hand over the back of the chair in such a way that their armpits rests on top of it; and that because it happens mostly during the weekend [especially on Saturday nights] when people usually got drunk, that it is nicknamed “Saturday Night Palsy”.

He yelled that that was his case! He had drank too much the previous night,which incidentally was a Saturday night,and had then fallen asleep on a chair in the position I just described.

Moment of truth. He pleaded for me to give him an “injection” so that it would resolve. I hesitated not knowing how to tell him that am not a doctor n there was no magical injection of the sort. He would have to wait on the nerve to heal itself gradually with time. And knowing what nerves are, permanent cells that are unlike the skin that heals rapidly, it may take just a few days, or up to 6 weeks to 6 months before Wallerian Regeneration [the type of healing nerves undergo] would have gone far enough to allow him use that hand again.

What i could do then was to splint the wrist and hang the limb on a sling to prevent edema and misalignment of the tendons which may lead to permanent disability and loss of function even after the nerve function finally returns. I also instructed him to see a Neurologist once he leaves 2 days from then.

With the look on his face when he was leaving, I’m sure he isn’t going to indulge in an alcoholic binge any time soon … or even ever. I felt for him, but there was nothing I could do. He simply has to be on conservative management, and maybe some nerve “boosters” which won’t do much anyway, until the nerves regain their function.

MORALS

- Just another reason you shouldn’t drink , and if you must, not irresponsibly at least. The cerebellum and the rest of the coordination system can’t do shit when the Ascending Reticular Formation, the awake-keeping system of the brain, is knocked silly with a combo of an Ali-Tyson-Floyd like knock-out punch from the bottles.

- Also now that you know there’s an important structure around your armpit region lying relatively unprotected and vulnerable, please don’t sit with your arm thrown across and over the backrest of a sit for long, no matter how relaxing and tempting that posture might be. Fact is whether drunk or not, the same principle and mechanism of injury with associated risk of Saturday Night type Radial Palsy is applicable.

Written by Kasiemobi Ifeanyichukwu Alamah