What is Entrapment Neuropathy?
Entrapment neuropathy- Entrapment neuropathy is a term used for conditions that cause pain, numbness, and weakness due to prolonged pressure or compression on a specific nerve.
The most commonly encountered conditions related to entrapment neuropathy includes:
Carpal tunnel syndrome- Carpal tunnel syndrome is a condition that causes numbness, tingling, or weakness in the hand. It occurs due to pressure on the median nerve. The median nerve goes from the arm to the hand. It passes through a space at the wrist called the carpal tunnel. When the space is narrow, the median nerve may become irritated causing numbness, tingling, and pain. The symptoms are usually in the thumb, index finger, middle finger, and half of the ring finger. Some people may also experience pain in the forearm, The symptoms do not typically affect the pinky finger.
Women are more likely to develop carpal tunnel syndrome. Risk factors for carpal tunnel include a wrist fracture, arthritis in the wrist, a history of diabetes, obesity, and working condition that causes repeated wrist flexion.
Carpal tunnel syndrome is diagnosed based on history, physical exam, and electromyography testing. It is best to treat carpal tunnel syndrome as soon as possible. In mild cases of carpal tunnel syndrome, it may be beneficial to sprint the wrist. Other treatment for carpal tunnel syndrome includes steroid injections and carpal tunnel release surgery. If carpal tunnel is severe, permanent weakness of grip and nerve damage may occur.
Cubital tunnel syndrome- Cubital tunnel syndrome causes tingling, pain, and numbness in the arms and hands. The ulnar nerve passes through the cubital tunnel at the elbow. When there is pressure on the ulnar nerve at the elbow it causes cubital tunnel syndrome. Symptoms of cubital tunnel syndrome include pain in the elbow, forearm, pinky finger, and half of the ring finger.
Electromyography testing is used to determine the severity of cubital tunnel syndrome. Early treatment for cubital tunnel syndrome includes rest, wearing an elbow splint at night, and avoiding elbow flexion. Other treatment options for cubital tunnel syndrome includes surgery.
Tarsal tunnel syndrome- Tarsal tunnel syndrome is a condition that causes numbness, tingling, pain, or a burning sensation in the foot. Tarsal tunnel syndrome is caused by pressure on the posterior tibial nerve as it passes through the tarsal tunnel at the ankle.
The condition may be caused by swelling related to an ankle sprain, osteoarthritis, or diabetes. Other causes of tarsal tunnel syndrome include flat feet, bone spurs, and varicose veins.
Tarsal tunnel syndrome is diagnosed based on medical history, physical exam, and electromyography testing. Treatment for tarsal tunnel syndrome includes a foot brace, anti-inflammatory medication, and steroid injections. Other treatment for tarsal tunnel syndrome includes tarsal tunnel release surgery.
Meralgia paresthetica- Meralgia paresthetica is a condition characterized by pain and numbness of the outer thigh. It is caused when the lateral femoral cutaneous nerve located in the leg is irritated. The nerve may become irritated due to excessive weight, pregnancy, a history of diabetes mellitus, or injury. Over the counter medication, weight loss, and wearing loose fitting clothes may improve the pain and numbness.
PERIPHERAL NEUROPATHY
Peripheral neuropathy- refers to a condition in which the peripheral nerves are damaged. The peripheral nerves carry messages to and from the brain and spinal cord. Peripheral nerves start from the spinal cord and travel to different areas of the body. Damage to these nerves can cause numbness, tingling, burning sensation, pain, and muscle weakness to the affected areas.
Peripheral neuropathy can be classified as a:
- Mononeuropathy- A mononeuropathy is a type of peripheral neuropathy that only affects one nerve. The causes for mononeuropathy include diabetes, trauma, infection, and immune system disorders. Mononeuropathy may also be caused by pressure on a single nerve.
- Polyneuropathy- Polyneuropathy occurs when there is damage to multiple peripheral nerves through the body. There are many causes for polyneuropathy including diabetes mellitus, complications from cancer or kidney disease, alcohol abuse, and vitamin B12 deficiency.
I. Length-dependent peripheral neuropathy-The symptoms includes tingling, numbness, and pain. The condition usually affects both sides of the body and starts with the longest nerves. People start with symptoms in the feet, and as the condition progresses symptoms begin to spread up the legs and affect the hands and arms. The condition also causes weakness as the condition progresses. Other symptoms related to peripheral neuropathy include lightheadedness when standing due to low blood pressure while standing.
II. Small fiber neuropathy- A condition characterized by damage to the narrow fibers of the peripheral nerves. The small fibers of the skin control sensory information such as temperature and pain. Small fiber neuropathy causes pain, burning sensation, pinprick sensation, numbness and tingling in the body. The symptoms are often made worse by wearing socks or bedsheets rubbing against a person’s feet. The symptoms typically start in the feet and move upward.
Small fiber neuropathy may be caused by many underlying diseases such as diabetes, thyroid disorders, and immune system disorder. Other causes of small fiber neuropathy include vitamin B12 deficiency, alcohol abuse, and chemotherapy.
Small fiber neuropathy is diagnosed based on history and physical exam. Electromyography testing may be ordered to rule out large fiber neuropathy. A skin biopsy may also be ordered to diagnose the condition. If there is an underlying cause for small fiber neuropathy, the treatment is dependent on the underlying condition. Treatments for small fiber neuropathy also include oral medication and topical creams to help with the pain related to the condition.
III. Chronic inflammatory demyelinating polyneuropathy (CIDP)- is a condition caused by inflammation of the peripheral nerves and nerve roots. The myelin sheath protects the nerves and helps the nerves send signals. The swelling causes damage to the myelin. The symptoms of the condition cause fatigue, pain, weakness, and numbness. A person must be experiencing the symptoms for at least 8 weeks for a person to be diagnosed with CIDP.
CIDP is diagnosed based on history and physical exam. Early treatment is needed to prevent worsening symptoms. Treatment for CIDP may include steroids to reduce inflammation. Antibody injections and immunotherapy medication may also be ordered to slow down the body’s immune response.