From the Research
Saturday night palsy should be treated with immediate removal of the compression source and conservative management, including wrist splinting and physical therapy, as most cases resolve spontaneously within 2-12 weeks. The condition typically occurs when pressure is applied to the arm for extended periods, often during intoxication, causing compression of the radial nerve against the humerus in the spiral groove and disrupting nerve conduction, primarily affecting motor function to the extensor muscles of the wrist and fingers 1. Initial evaluation should include a thorough neurological examination focusing on wrist and finger extension, thumb abduction, and sensation over the dorsal hand.
Key aspects of treatment include:
- Wrist splinting in a neutral or slightly extended position to prevent contractures
- Regular removal of the splint for gentle range of motion exercises 3-4 times daily
- Early initiation of physical therapy to maintain joint mobility and prevent muscle atrophy
- Pain management with NSAIDs such as ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily
For severe cases or those showing no improvement after 3-4 weeks, electrodiagnostic studies (EMG/NCS) should be considered to assess nerve damage severity, as suggested by the case report of sleep palsy (Saturday-night palsy) of the deep radial nerve 1. Surgical decompression is rarely needed but may be considered if there's no improvement after 3-4 months or if imaging reveals structural causes of compression. Recovery monitoring should include regular strength assessments of wrist and finger extension.