Presenting Complaints:
The patient, a 28-year-old male, presents with a complaint of weakness and numbness in his right upper extremity, specifically the forearm and hand. He reports that the symptoms began after a night of heavy drinking and falling asleep with his arm draped over the back of a chair. He woke up the following morning with the inability to move his arm and noticed a tingling sensation.
History of Presenting Complaints:
The patient states that he initially attributed the symptoms to a common “pins and needles” sensation from sleeping in an awkward position. However, as the day progressed, he realized that he was unable to perform basic motor functions with his right hand, such as gripping objects or making a fist. He also noticed a loss of sensation in the affected area.
Chief Complaints:
The patient’s chief complaints include weakness and numbness in the right forearm and hand, as well as difficulty performing daily activities that require fine motor skills.
Past Medical and Surgical History:
The patient has no significant past medical or surgical history.
Family History:
There is no relevant family history of neurological disorders or conditions.
Socioeconomic Status:
The patient is employed full-time in a physically demanding job and has health insurance coverage.
Present and Pre-morbid Functional Status:
Prior to the current episode, the patient had no limitations in his functional abilities and enjoyed an active lifestyle.
General Health Status:
The patient is generally healthy, with no known chronic medical conditions.
Vitals:
Vital signs are within normal limits.
Aggravating Factors:
The patient reports that any attempts to move or use his right arm exacerbate the symptoms of weakness and numbness.
Easing Factors:
Resting the affected arm and avoiding any activities that require its use provide some relief from the symptoms.
Examination:
On physical examination, there is evidence of reduced muscle strength and sensation in the right forearm and hand. The extensor muscles of the wrist and fingers are particularly affected. There are no signs of muscle atrophy or abnormal reflexes. The rest of the neurological examination is unremarkable.
Sleep and 24-hour Pattern:
The patient reports disturbed sleep due to discomfort and pain in the affected arm. He experiences difficulty finding a comfortable position that does not exacerbate the symptoms.
Duration of Current Symptoms:
The patient reports that the symptoms have been present for 24 hours.
Mechanism of Injury/Current Symptoms:
The patient’s symptoms are consistent with Saturday Night Palsy, which is caused by compression or stretching of the radial nerve. In this case, the patient’s arm was draped over the back of a chair for an extended period while he was intoxicated, leading to nerve compression and subsequent nerve damage.
Progression Since the Current Episode:
Since the initial onset of symptoms, there has been no significant improvement or worsening.
Significant Prior History:
There is no significant prior history related to the current complaint.
Previous Treatment:
The patient has not sought any medical treatment for this condition before presenting to the clinic.
Diagnostic Tests/Imaging:
A thorough physical examination and clinical history are suggestive of Saturday Night Palsy. However, to confirm the diagnosis and rule out other potential causes, further diagnostic tests such as electromyography (EMG) and nerve conduction studies may be performed.
Differential Diagnosis:
The differential diagnosis for the patient’s symptoms includes other nerve entrapment syndromes, such as carpal tunnel syndrome or ulnar nerve entrapment. Traumatic injuries to the upper extremity and peripheral neuropathies should also be considered.
Postural Observation:
Observation reveals a lack of muscle tone and reduced grip strength in the affected right hand. The patient exhibits a functional impairment when attempting to perform tasks requiring fine motor skills.
Precaution and Contraindications:
The patient should avoid any activities that may further compress or stretch the radial nerve in the affected arm. Immobilization of the arm should be avoided to prevent muscle atrophy and joint stiffness.
Functional Movement Analysis (Sign):
The patient demonstrates a reduced ability to extend the wrist and fingers of the right hand, compromising his ability to grasp objects or perform tasks requiring manual dexterity.
Quick Screening Tests/Clearing of Additional Joint Structures:
Quick screening tests for other joint structures are within normal limits, indicating that the primary issue lies with the radial nerve.
Range of Motion (ROM):
The ROM of the affected wrist and fingers is significantly limited due to weakness and numbness.
Special Tests:
Additional special tests, such as the Tinel’s sign and Phalen’s test, may be performed to rule out other nerve entrapment syndromes, but they are unlikely to be positive in this case.
Assessment:
Based on the patient’s history, physical examination, and mechanism of injury, the assessment suggests Saturday Night Palsy, a compression injury to the radial nerve.
Problem List/Complaints:
- Weakness and numbness in the right forearm and hand.
- Loss of fine motor skills in the right hand.
- Pain and discomfort in the affected arm.
- Sleep disturbance due to symptoms.
Treatment:
- Immobilization: The patient may be advised to wear a wrist splint or brace to immobilize the wrist and reduce further nerve compression.
- Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesics may be prescribed to manage pain and discomfort.
- Physical Therapy: The patient should be referred to a physical therapist for exercises aimed at improving muscle strength, range of motion, and coordination.
- Patient Education: The patient should be educated about the condition, including the importance of avoiding further nerve compression, the use of proper posture, and self-management strategies for pain relief.
Prognosis:
With appropriate treatment and compliance with physical therapy exercises, the prognosis for Saturday Night Palsy is generally favorable. Most patients experience significant improvement within a few weeks to months, with a full recovery expected.
Goals:
- Reduce pain and discomfort in the affected arm.
- Restore muscle strength and coordination in the right forearm and hand.
- Improve range of motion and functional abilities of the wrist and fingers.
- Facilitate a return to normal activities and daily functioning.
Interventions:
- Wrist Splint: The patient will be fitted with a wrist splint to immobilize the wrist and minimize further nerve compression.
- Physical Therapy: The patient will undergo a physical therapy program consisting of exercises to improve muscle strength, range of motion, and coordination.
- Pain Management: Medications, such as NSAIDs or analgesics, will be prescribed to manage pain and discomfort.
Patient Education:
The patient will be educated about the nature of Saturday Night Palsy, the importance of adhering to treatment recommendations, and self-management strategies to minimize further nerve compression.
Patient/Family Education:
The patient’s family will be educated about the condition, the treatment plan, and the importance of providing support and assistance during the recovery process.
Discharge Plan:
The patient will be discharged with a prescription for pain medication, a wrist splint, and a referral to a physical therapist for ongoing rehabilitation. A follow-up appointment will be scheduled to monitor progress and make any necessary adjustments to the treatment plan. The patient will be advised to avoid activities that may exacerbate symptoms and to notify the healthcare provider if there are any concerns or worsening of symptoms.