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Peripheral Nerve Entrapment Syndrome


Peripheral Neuropathy and Nerve Entrapment Syndromes


Any kind of damage to the nerves located outside of the brain and spinal cord (peripheral nerves) is called as Peripheral neuropathy. Peripheral neuropathy is always a by product of Chronic inflammation of the nerve. There are more than 100 known causes and many a times unknown causes behind development of neuropathy.

Signs and Symptoms:



  • Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
  • Sharp, jabbing, throbbing or burning pain
  • Extreme sensitivity to touch
  • Pain during activities that shouldn't cause pain, such as pain in your feet when putting weight on them or when they're under a blanket
  • Lack of coordination and falling
  • Muscle weakness
  • Feeling as if you're wearing gloves or socks when you're not
  • Paralysis if motor nerves are affected

If autonomic nerves are affected, signs and symptoms might include:


  • Heat intolerance
  • Excessive sweating or not being able to sweat
  • Bowel, bladder or digestive problems
  • Drops in blood pressure, causing dizziness or light headedness

Causes:


  • Autoimmune diseases. These include Sjogren's syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.
  • Diabetes. This is the most common cause. Among people with diabetes, more than half will develop some type of neuropathy.
  • Infections. These include certain viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, leprosy, diphtheria, and HIV.
  • Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.
  • Tumors. Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves or press on nerves. Also, polyneuropathy can arise as a result of some cancers related to the body's immune response. These are a form of a degenerative disorder called paraneoplastic syndrome.
  • Bone marrow disorders. These include an abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (myeloma), lymphoma and the rare disease amyloidosis.
  • Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidism).

Other causes of neuropathies include:


  • Alcoholism. Poor dietary choices made by people with alcoholism can lead to vitamin deficiencies.
  • Exposure to poisons. Toxic substances include industrial chemicals and heavy metals such as lead and mercury.
  • Medications. Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy.
  • Injury or pressure on the nerve. Injuries, such as from motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion such as typing many times.
  • Vitamin deficiencies. B vitamins — including B-1, B-6 and B-12 — vitamin E and niacin are crucial to nerve health.

Nerve entrapment syndromes:


Nerve entrapment syndrome is a group of disorders characterized by loss of function (Sensory or/and motor) of the peripheral nerves as a result of chronic compression.

The main function of the peripheral nerves is to carry information to and fro between the peripheral structures and the brain. Unfortunately, these nerves are vulnerable to compressions at various regions of the extremities, specially at the “Osseo-ligamentous Tunnel regions”. At these sites, nerves are subjected to repetitive rubbing or sliding against the bones surface which results in Ischemic changes and edema in the outer layers of the nerve (myelin sheath) ultimately leading to Focal demyelination at the sites of nerve compression.



Some commonly entrapped nerves in our body are


  1. Median nerve (Carpal tunnel syndrome, Pronator teres syndrome)
  2. Posterior Tibial nerve (Tarsal tunnel syndrome)
  3. Lateral Femoral Cutaneous nerve (Meralgia paresthetica)
  4. Radial nerve (Radial tunnel syndrome)
  5. Ulnar nerve (Cubital tunnel syndrome, Guyon’s canal syndrome)
  6. Suprascapular nerve, Dorsal scapular nerve
  7. Peroneal nerve
  8. Pudendal nerve (Pudendal neuralgia)


JEEVISHA Protocol for management of Peripheral neuropathy:


  1. Management of the primary pathology producing neuropathy is of utmost importance and should be done along side the course of pain management. Thus, if Diabetes is the cause for neuropathy, good glycemic control of the patient is our target.
  2. Medications: Patients are started on some Neuropathic medications. Other medications are started seeing the response and side effects of the medications.
  3. Physiotherapy: Targeted Physical therapy is started in patients where motor nerves are involved and muscles are week.
Targeted treatment:
  1. Fluoroscopy guided sympathetic ganglia injections/ Radiofrequency ablation
  2. Fluoroscopy guided peripheral nerve injections/Pulsed Radiofrequency ablation
  3. Ultrasound guided nerve hydro-dissections in cases of Nerve entrapment syndromes
  4. Spinal cord stimulator insertion