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.
Reacting to stimuli is what nervous tissues are designed to do but they can react in negative fashion if the applied stimulus is too large or lasts too long. Pressure applied for a long period or a direct blow to an area can both cause nerve trauma, with honeymooners' palsy being the term for nerve damage caused by one partner using the other's arm as a pillow during sleep. Longer term nerve pressure can disrupt the blood supply to the nerve and compromise the function of the nerve, a condition called neurapraxia.
A neurapraxia is the mildest form of the classification categories of nerve injuries which also includes axonotmesis and neurotmesis. In a neurapraxia the nerve is damaged but there is no mechanical disruption of the structure of the nerve sheath or the axon within, so regeneration does not need to occur as in the more severe syndromes. The conduction of impulses is interrupted by the trauma, leading to a loss of motor power with a variable amount of sensory change. There may be a lack of local blood supply from compression which leads to local biochemical changes in the nerve.
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.
Once the paralysis has occurred the arm will need to be supported by a sling to prevent shoulder problems and the person taught to check the arm regularly if there is any sensory loss. Sensory loss means that the arm can be damaged without the person realising it, so they have to be vigilant in looking after the limb until it recovers. Other ways of getting this kind of nerve trauma is in sport, by leaning against a solid edge for a long time or by falling asleep on the toilet for some hours.
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.
Reacting to stimuli is what nervous tissues are designed to do but they can react in negative fashion if the applied stimulus is too large or lasts too long. Pressure applied for a long period or a direct blow to an area can both cause nerve trauma, with honeymooners' palsy being the term for nerve damage caused by one partner using the other's arm as a pillow during sleep. Longer term nerve pressure can disrupt the blood supply to the nerve and compromise the function of the nerve, a condition called neurapraxia.
A neurapraxia is the mildest form of the classification categories of nerve injuries which also includes axonotmesis and neurotmesis. In a neurapraxia the nerve is damaged but there is no mechanical disruption of the structure of the nerve sheath or the axon within, so regeneration does not need to occur as in the more severe syndromes. The conduction of impulses is interrupted by the trauma, leading to a loss of motor power with a variable amount of sensory change. There may be a lack of local blood supply from compression which leads to local biochemical changes in the nerve.
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.
Once the paralysis has occurred the arm will need to be supported by a sling to prevent shoulder problems and the person taught to check the arm regularly if there is any sensory loss. Sensory loss means that the arm can be damaged without the person realising it, so they have to be vigilant in looking after the limb until it recovers. Other ways of getting this kind of nerve trauma is in sport, by leaning against a solid edge for a long time or by falling asleep on the toilet for some hours.
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Edinburgh. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
No comments:
Post a Comment