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Pressure Palsy – Causes, Symptoms and Treatment

Pressure palsy is a temporary weakness or paralysis of a nerve caused by prolonged mechanical compression of nerve tissue. It is usually fully reversible.

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Things worth knowing about "Pressure Palsy"

Pressure palsy is a temporary weakness or paralysis of a nerve caused by prolonged mechanical compression of nerve tissue. It is usually fully reversible.

What Is Pressure Palsy?

Pressure palsy (also known as compression neuropathy or entrapment neuropathy) is a functional impairment of a peripheral nerve caused by sustained or intense mechanical pressure applied to that nerve. The result is temporary weakness or complete paralysis of the muscles supplied by the affected nerve, often accompanied by numbness or tingling in the corresponding skin area.

Pressure palsies are among the most common peripheral nerve injuries and are fully reversible in most cases, provided the source of compression is identified and removed in time.

Causes

Pressure palsy occurs when a nerve is compressed over a prolonged period or with sufficient force. Common causes include:

Sleep-related postures: Prolonged lying on an arm or leg, for example the so-called Saturday night palsy (radial nerve compression during sleep)
External compression: Tight plaster casts, splints, crutches (crutch palsy), or tight-fitting clothing
Intraoperative positioning: Improper positioning during surgical procedures
Occupational or sports-related pressure: Repetitive pressure from tools or specific activities
Anatomical constrictions: Bony prominences or joints that compress a nearby nerve

Symptoms

The symptoms of a pressure palsy depend on which nerve is affected. General signs include:

Muscle weakness or paralysis in the area supplied by the affected nerve
Numbness (hypaesthesia) or tingling (paraesthesia) in the corresponding skin region
Pain at the site of compression or along the nerve distribution
Reduced or absent reflexes in the affected area

Commonly Affected Nerves

Radial nerve: Radial nerve palsy causing wrist drop (inability to extend the wrist and fingers)
Common peroneal nerve: Foot drop with weakness of ankle dorsiflexion (steppage gait)
Ulnar nerve: Ulnar nerve palsy with weakness of intrinsic hand muscles
Median nerve: For example, in carpal tunnel syndrome

Diagnosis

Diagnosis of pressure palsy is typically based on a combination of:

Medical history: Inquiry about sleeping positions, occupational strain, plaster casts, or recent surgical procedures
Clinical neurological examination: Assessment of motor function, sensation, and reflexes
Electroneurography (ENG) and electromyography (EMG): Measurement of nerve conduction velocity and muscle activity to localize and grade the nerve injury
Imaging: Ultrasound or MRI to visualize the nerve and any compressing structures

Treatment

Treatment depends on the underlying cause and severity of the pressure palsy:

Pressure relief: Removing the source of compression is the most important step (repositioning, removal of bandages, casts, or splints)
Physiotherapy: Exercise therapy to maintain muscle strength and joint mobility, and to promote nerve regeneration
Pain management: Analgesics or neuropathic pain medications (e.g., gabapentin) if needed
Orthoses: Supportive devices such as foot drop orthoses for peroneal palsy or wrist splints for radial palsy during the recovery period
Surgical intervention: In cases of persistent compression due to anatomical structures, nerve decompression surgery may be required

Prognosis

The prognosis for pressure palsy is generally favorable when the cause is identified and relieved promptly. Mild cases often resolve within hours to a few weeks. More severe injuries involving axonal damage may require several months for full recovery, as peripheral nerves regenerate at approximately 1 mm per day. In rare cases, permanent neurological deficits may remain.

References

Mumenthaler M., Mattle H., Taub E. - Neurological Differential Diagnosis, Thieme Publishing, 6th Edition, 2014
Sunderland S. - Nerve Injuries and Their Repair: A Critical Appraisal. Churchill Livingstone, 1991
Spinner R.J., Amadio P.C. - Compressive neuropathies of the upper extremity. Clinical Orthopaedics and Related Research, 2003

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