Patients also lose the ability to extend the thumb, resulting in difficulty with opening the hand and grasping objects. This leads to an inability to extend the wrist and fingers at the level of the metacarpophalangeal joints. On physical exam, patients may demonstrate a characteristic wrist drop, which results from the loss of extensor muscle function controlled by the radial nerve branches and preservation of the flexor muscles controlled by other nerves in the hand and arm. Patients may report numbness, weakness, tingling, pain, or any combination of these. Symptoms can also begin several days after the initial insult, leading to a delayed presentation. It is possible that patients may not provide this info until prompted, as it can go unrecognized as the inciting event. Otherwise, patients may report some other mechanism by which compression would have been unnaturally placed on the upper medial arm or axilla. Patients will often report symptom onset after consuming a large amount of alcohol and then sleeping in an unnatural position. This includes but is not limited to compressive clothing or accessories, improper use of crutches, prolonged blood pressure cuff usage, and more. While these are the classically described presentations, one must be aware that Saturday night palsy can be caused by any unnatural positioning or use of the limbs that can cause compression by a similar mechanism. Honeymoon palsy, on the other hand, refers to an individual falling asleep on the arm of another and consequently compressing that person's nerve. Saturday night palsy classically involves an individual falling asleep with the arm hanging over a chair or other hard surface, leading to compression within the axilla. Intoxicated individuals may not retain the reflexive ability to correct their position while asleep.
Both names suggest a scenario where immobilization in an unnatural position can result in prolonged compressive damage onto the radial nerve.
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