Podcast
Questions and Answers
What is the primary cause of entrapment neuropathies?
What is the primary cause of entrapment neuropathies?
What is the consequence of prolonged ischemia in entrapment neuropathies?
What is the consequence of prolonged ischemia in entrapment neuropathies?
What is the result of extraneural pressures on intraneural venous circulation?
What is the result of extraneural pressures on intraneural venous circulation?
Which of the following is a complication of entrapment neuropathies?
Which of the following is a complication of entrapment neuropathies?
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What is the role of neuroinflammation in entrapment neuropathies?
What is the role of neuroinflammation in entrapment neuropathies?
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Which of the following nerve entrapments is most commonly associated with foot drop?
Which of the following nerve entrapments is most commonly associated with foot drop?
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What is the primary purpose of anesthetics in diagnosing nerve entrapment?
What is the primary purpose of anesthetics in diagnosing nerve entrapment?
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Which of the following is a common symptom of chronic nerve entrapment?
Which of the following is a common symptom of chronic nerve entrapment?
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What is the primary role of electrodiagnostic testing in diagnosing nerve entrapment?
What is the primary role of electrodiagnostic testing in diagnosing nerve entrapment?
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Which of the following types of nerve entrapment affects the supraspinatus fossa?
Which of the following types of nerve entrapment affects the supraspinatus fossa?
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Study Notes
Entrapment Neuropathies
- Caused by compression and/or irritation of peripheral nerves as they travel through narrow anatomical spaces
- Common causes include: repetitive motion, inflammation, anatomical abnormalities, prior fractures or dislocations, scar tissue or myofascial tension, bone spurs, arthritis, swelling, edema, cysts, repetitive or prolonged activities, and systemic conditions like diabetes
Pathophysiology
- Ischaemia, Oedema & Intraneural Fibrosis: mild entrapment neuropathies cause intraneural ischemia, disrupting intraneural venous circulation
- Demyelination & Axon Degeneration: prolonged ischemia causes demyelination and axon degeneration, affecting large myelinated fibers
- Neuroinflammation: activation of immune cells releases inflammatory mediators, contributing to neuropathic pain
- Changes to Axonal Transport: compression and inflammation impair retrograde and anterograde axonal transport, increasing nerve mechanosensitivity
- Central Nervous System Contributions: peripheral nerve injuries can cause central changes, including bilateral sensory deficits, widespread hypersensitivity, and impaired pain modulation
Clinical Symptoms
- Sensory abnormalities, pain, paresthesia, and motor paralysis
- Localized or referred pain, numbness, tingling, electric shock sensation
- Muscle weakness and wasting, dry, thin skin in chronic cases
Common Types of Nerve Entrapments
- Carpal Tunnel Syndrome (CTS): affects the median nerve
- Cubital Tunnel Syndrome: affects the ulnar nerve
- Thoracic Outlet Syndrome (TOS): affects the lower trunk
- Suprascapular Nerve Entrapment: affects the supraspinatus fossa
- Axillary Nerve Entrapment: affects the quadrilateral space
- Radial Nerve Entrapments: includes PIN syndrome, radial tunnel syndrome, and Wartenberg’s syndrome
- Sciatic Neuropathy: can result from various conditions like piriformis syndrome
- Common Peroneal Nerve Entrapment: causes foot drop
- Tibial Nerve Entrapment: includes tarsal tunnel syndrome
- Interdigital Neuroma (Morton's Neuroma): affects the interdigital nerves
Diagnosis
- Visual Inspections: focus on limb asymmetry, muscular atrophy, and abnormal posture
- Palpation: attempt to reproduce symptoms by pressing or scratching the affected area
- Nerve Tension Tests: Straight Leg Raise (SLR), Slump Test, Neural Thomas Test, Upper Limb Tension Tests (ULTT)
- Anesthetics and Electrodiagnostic Testing: local anesthetic administration can confirm symptoms, and electrodiagnostic testing (EDS) helps diagnose nerve entrapment
- Imaging and Nerve Conduction Studies: MRI and ultrasound provide detailed anatomical information, and nerve conduction studies help diagnose distal neuropathy
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Description
This quiz covers the causes and etiology of entrapment neuropathies, including repetitive motion, inflammation, anatomical abnormalities, and other factors that contribute to nerve compression.
