Entrapment neuropathy

Entrapment neuropathy: Description, Causes and Risk Factors:The term entrapment neuropathies refers to isolated peripheral nerve injuries occurring at specific locations where a nerve is mechanically constricted in a fibrous or fibro-osseous tunnel or deformed by a fibrous band. In some instances the nerve is injured by chronic direct compression, and in other instances angulation or stretching forces cause mechanical damage to the nerve.Entrapment neuropathy usually occur near joints where the nerve passes through a ?brous tunnel as it courses from one body segment to the next. Examples are carpal tunnel syndrome, an injury to the median nerve at the wrist, and cubital tunnel syndrome, an injury to the ulnar nerve at the elbow.External pressure reduces flow in the vessels supplying the nerve with blood (vasa nervorum). This causes local ischemia, which has an immediate effect on the ability of the nerve axons to transmit action potentials. As the compression becomes more severe over time, focal demyelination occurs, followed by axonal damage, and finally scarring.Entrapment neuropathy of the ulnar nerve are relatively common with ulnar neuropathy at the elbow more prevalent than ulnar neuropathy at the wrist.Occasionally, other disorders of peripheral nerve can mimic Entrapment neuropathy. Such conditions are important to recognize since the Pathophysiology of these neuropathies is intrinsic to peripheral nerves, and they do not require surgical therapy. One such neuropathy is hereditary neuropathy with liability to pressure palsies (HNPP). This autosomal-dominant inherited neuropathy is most commonly due to a 1.5 megabase (Mb) deletion on chromosome 17p11.2 which encompasses the gene for the peripheral myelin protein PMP22. A few cases are due to a frame shift mutation in the PMP22 gene. This disease commonly presents with recurrent transient sensorimotor neuropathies that are typically painless.Symptoms of Entrapment neuropathy:Entrapment neuropathyIts symptoms include pain, tingling, numbness, and muscle weakness. The symptoms affect just one particular part of the body, depending which nerve is affected.Positive sensory symptoms are usually the earliest to occur, particularly tingling and neuropathic pain, followed or accompanied by reduced sensation or complete numbness. Muscle weakness is usually noticed later, and is often associated with Muscle atrophy.Diagnosis Entrapment neuropathy:Entrapment neuropathy can usually be diagnosed confidently on the basis of the symptoms and signs alone. However, nerve conduction studies are helpful in confirming the diagnosis, quantifying the severity, and ruling out involvement of other nerves (suggesting a mononeuritis multiplex or polyneuropathy). A scan is not usually necessary, but may be helpful if a tumor or other local compressive lesion is suspected.Sensory nerve conduction studies are the earliest to show abnormality of slowing (focal demyelination) in the nerve across the site of the entrapment. Motor conduction abnormalities generally present later with slowing across the site followed by loss of axons (both sensory and motor) if the entrapment is unrelieved.Needle electromyography is used to detect axon loss which is chronic unless there is a super added acute external pressure on an existing entrapped nerve.Treatment:Initial treatment can be symptomatic, comprising of rest, avoidance of vibratory tools, or repetitive activity. Changing work profile and Drug therapy which can be a combination of NSAIDs and oral as well as local steroids.Some compression neuropathies are amenable to surgery: carpal tunnel syndrome and cubital tunnel syndrome are two common examples. Whether or not it is appropriate to offer surgery in any particular case depends on the severity of the symptoms, the risks of the proposed operation, and the prognosis if untreated. After surgery, the symptoms may resolve completely, but if the compression was sufficiently severe or prolonged then the nerve may not recover fully and some symptoms may persist.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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