Peripheral Nerve Entrapment Research Articles

Carpal tunnel syndrome and work.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, and it frequently presents in working-aged adults. Its mild form causes 'nuisance' symptoms including dysaesthesia and nocturnal waking. At its most severe, CTS can significantly impair motor function and weaken pinch grip. This review discusses the anatomy of the carpal tunnel and the clinical presentation of the syndrome as well as the classification and diagnosis of the condition. CTS has a profile of well-established risk factors including individual factors and predisposing co-morbidities, which are briefly discussed. There is a growing body of evidence for an association between CTS and various occupational factors, which is also explored. Management of CTS, conservative and surgical, is described. Finally, the issue of safe return to work post carpal tunnel release surgery and the lack of evidence-based guidelines are discussed.

Cross-sectional sonographic assessment of the posterior interosseous nerve.

Cross-sectional sonographic measurements are considered first-line confirmatory tests in diagnosing peripheral nerve entrapment syndromes. Our aim is to establish normal values of cross-sectional area of the posterior interosseous nerve (PIN) at the arcade of Frohse, the most common site of compression of this nerve. The PIN was identified with ultrasound on 50 healthy adults and 30 cadavers. Measurements of the cross-sectional area (CSA), antero-posterior (AP) and lateral (L) distances were taken immediately proximal and distal to the arcade of Frohse. The mean AP and L distances of the PIN proximal to the arcade of Frohse were 0.111 cm (0 ± 0.021) and 0.266 cm (±0.058), respectively, while the mean AP and L distances of the PIN distal to the arcade of Frohse were 0.085 cm (±0.019) and 0.343 cm (±0.057), respectively. P squared testing showed a statistically significant difference between the AP and lateral distances of the PIN when comparing proximal and distal to the arcade (p ≤ 0.001). However, the mean CSA of the PIN measured immediately proximal to the arcade of Frohse was 0.022 cm(2) (±0.005); immediately distal to the arcade of Frohse, it was 0.023 cm(2) (±0.004). t test showed no statistical difference between the two regions (p = 0.11). Our study has provided reference values for the PIN in healthy individuals at the arcade of Frohse. Although, there is a flattening of the nerve as it enters the supinator muscle, this should not be mistaken for nerve entrapment as the size of the nerve remains consistent.

Peripheral nerve entrapment neuropathy for neurosurgeon

Peripheral nerve entrapment neuropathy for neurosurgeon

Peripheral Nerve Entrapment Impairments: Part II, Electrodiagnosis

Peripheral Nerve Entrapment Impairments: Part II, Electrodiagnosis

2090786 US-Guided Hydrodissection in Peripheral Nerve Entrapment Syndromes: Preliminary Review Of Efficacy And Outcomes

2090786 US-Guided Hydrodissection in Peripheral Nerve Entrapment Syndromes: Preliminary Review Of Efficacy And Outcomes

Activation of the serratus anterior and upper trapezius in a population with winged and tipped scapulae during push-up-plus and diagonal shoulder-elevation

Scapular winging and tipping are types of abnormal scapular kinematics, which is caused by not only the entrapment of peripheral nerve, but also imbalance of the scapulothoracic musculatures. The purpose of this study was to investigate the presence of muscular imbalance in the middle and lower parts of the serratus anterior and upper trapezius in people with scapular winging and tipping. Twenty male participants (age, 23.0 ± 1.92 y) were placed into symptomatic group (n = 10) and control group (n = 10). Participants completed two individual trials of a push-up plus, and a diagonal shoulder elevation, while electromyography (EMG) recorded muscle activity of the low and middle serratus anterior and upper trapezius. The root mean squared EMG values for three muscles were normalized using maximum voluntary isometric contractions (%MVIC). The value was calculated using modified isolation equation for comparing activation of middle and lower serratus anterior (%isolation). During a diagonal shoulder elevation, the % maximal voluntary isometric contraction (%MVIC) data showed that the symptomatic participants had significantly greater activation of the middle serratus anterior compared to the control group (P = 0.01). During a diagonal shoulder elevation, the symptomatic participants had not only significantly increased %isolation of the middle serratus anterior, but also significantly decreased for the lower serratus anterior compare with the control group (p = 0.00). Present result indicated that different muscle activation between middle and lower serratus anterior could represent in group with scapular dyskinesis, and need for selective activation of the lower serratus anterior in patients with scapular winging and tipping.

Modified Infiltration Technique for Cutaneous Nerve Entrapment Syndrome

Lateral thoracic or abdominal cutaneous nerve entrapment syndrome (C.N.E.S.) refers to the pain originating from thoracic or abdominal wall. It is a common ailment which is often misdiagnosed as arising from a source inside the abdominal cavity mistakenly leading to inappropriate diagnostic investigations, unsatisfactory treatment, and considerable costs. The thoracoabdominal nerves terminate as the cutaneous nerves at a point from which accessory branches are given off in the rectus channel ending in the skin. Peripheral nerve entrapment occurs at anatomic sites where the nerve changes direction to enter a fibrous or osseofibrous tunnel because mechanically induced irritation is most likely to occur at these locations. Controlled investigations demonstrate that satisfactory alleviation is to be gained by immediate intervention by the most widely adopted technique of a fanning infiltration of the region of maximal point of tenderness with anesthetic and anti-inflammatory agents. Unfortunately, we observe that clinicians inexperienced performing this procedure are deterred from this technique owing to fears of inaccurate medication deposition or penetrating the abdominal cavity and perforating viscera. In this paper we describe a method to provide a safe and accurately targeted injection precisely at the necessary location without risking iatrogenic harm. This is easily achieved by raising a mound of the superficial soft tissue at the point of maximal tenderness and inserting the needle oriented Method Article Naimer; BJMMR, 7(8): 672-677, 2015; Article no.BJMMR.2015.375 673 parallel to the surface of the anterior body surface. Adoption of this method provides a simple, safe and effective solution for C.N.E.S. and will allow recruiting more physicians to join the circle of those actively treating this condition.

Peripheral nerve entrapment, hydrodissection, and neural regenerative strategies

Peripheral nerve entrapments are an underrecognized cause of pain and disability. Hydrodissection (perineural deep injections) is one of the techniques that can release the entrapped nerve. Futhermore, discussed are the techniques of neural therapy, neural prolotherapy (perineural injection therapy), and autologous platelet lysate, as well as the use of adipose-derived stem cells.

Peripheral Nerve Entrapment Impairments Revisited: Part I

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, introduced the concept of diagnosis-based impairments (DBI), and a modified version of this method can be used in rating peripheral nerve injury in general (Section 5.4) and upper limb entrapment syndromes (Section 15.4f). The first portion of this article reviews the evaluation of upper extremity nerve impairment and summarizes inclusion criteria and causation correlation for carpal tunnel syndrome, Guyon's canal syndrome, cubital tunnel syndrome, anterior interosseous, Wartenberg's syndrome, and radial tunnel syndrome. Very mild nerve entrapments do exist and may fail to meet the AMA Guides criteria for impairment related to a diagnosis of nerve entrapment. Electrodiagnostic examination includes nerve conduction studies that assess the largest, most heavily myelinated axons, and needle electromyelography, which detects muscle membrane instability but not the sensory function of nerves. A case example from the AMA Guides, Sixth Edition, shows the process of permanent impairment rating in a case of carpal tunnel syndrome. Determination of impairment for peripheral nerve entrapments can be easily accomplished once one understands how to determine if the nerve under consideration from the electrodiagnostic evaluation demonstrates a conduction delay, a conduction block, or an axon loss. This establishes the test findings that usually are the only objective findings present.

Investigating persistent bilateral ankle swelling

This paper presents a case-report of a young female reporting sudden onset ankle swelling and pain, subcutaneous inflmmation and progressive bilateral pes planus, in the context of no associated co-morbidities or risk factors for autoimmune and infective conditions. We discussed the appropriate imaging techniques which facilitated the diagnosis, which included Xrays, ultrasound and MRI scans used to rule out soft tissue injuries, stress fractures, inflmmatory arthritis, and other causes of peripheral nerve entrapment and tendon pathology. The patient was diagnosed with polyarteritis nodosa based on deep skin biopsy. This is the fist case ever reported showing signifiant peripheral nerve enlargement in the context of small vessel vasculitis. The imaging step-up approach is discussed in relation to the sensitivity and specifiity of different imaging techniques for assessing joint, bone, tendon, ligament and nerve-related pathology. The rarity of this diagnosis in the context of a very common presentation emphasised the need for specialist referral and has signifiant educational value.

Efficacy of Subcutaneous Hydrocortisone Injection in Patients Diagnosed With Chronic Abdominal Wall Pain

Introduction: Chronic abdominal wall pain (CAWP) occurs in up to 10% of patients referred to gastroenterology clinics for abdominal pain. It represents a focal pain thought related to peripheral nerve entrapment. We describe the single-center experience for management of chronic abdominal wall pain using injection of hydrocortisone with local anesthetic. Methods: A total of 22 patients with diagnosis of chronic abdominal wall pain by physical examination were treated with a subcutaneous injection of hydrocortisone 100 mg/mL (3-5 mL) with a local anesthetic (Sensorcaine or Marcaine) at the point of maximal pain. We described treatment response as no need for subsequent intervention including recurrent clinic visit for pain, imaging for pain, narcotic use, repeat injections, or additional referrals needed for abdominal pain. Response was measured over yearly time points. We assessed post-treatment outcomes including response rate at 1 year and 3 years, number of return visits for abdominal pain, narcotic use, imaging studies, and physical therapy referral. Results: Between 1995 and 2013, 22 patients with chronic abdominal wall pain received subcutaneous injection of hydrocortisone. Eighty-one percent were female. Eighty-one percent were white. Median age was 56.5 years (range 17-79 years). A number of patients were on proton pump inhibitor (50%) or treatment for irritable bowel syndrome (50%) at the time of injection. The overall response rate after subcutaneous injection at 1 year and at 3 years was 55% for both. Only 6 patients (27%) required repeat injection. The average period of time before repeat injection was 4 months. Twenty-seven percent of patients required imaging for abdominal pain within 3 years. Only 4% required addition of narcotics for abdominal pain at any time. Thirteen percent of patients required referral to physical therapy. Conclusion: In our single center evaluation of patients with a clinical diagnosis of chronic abdominal wall pain treated with hydrocortisone injection, 55% experienced ongoing treatment response up to 3 years after therapy. Further randomized, placebo-controlled evaluations would be valuable to determine the true efficacy of this intervention.

Altered Median Nerve Deformation and Transverse Displacement during Wrist Movement in Patients with Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Strong pinch or grip with wrist flexion has been considered a risk factor for CTS. Studying median nerve displacement during wrist movements may provide useful information about median nerve kinematic changes in patients with CTS. The purpose of this study was to evaluate the deformability and mobility of the median nerve in patients with CTS compared to healthy subjects. Dynamic ultrasound images were obtained in 20 affected wrists of 13 patients with CTS. Results were compared to complementary data obtained from both wrists of 10 healthy subjects reported in a previous study. Shape and position of initial and final median nerve were measured and analyzed for six defined wrist movements. The deformation ratios for each movement were defined as the median nerve area, perimeter, and circularity of the final position normalized by respective values assessed in the initial position. The median nerve displacement vector and magnitude were also calculated. The deformation ratio for circularity was significantly less in patients with CTS compared to healthy subjects during wrist flexion (P < .05). The mean vector of median nerve displacement during wrist flexion was significantly different between patients with CTS and healthy subjects (P < .05). The displacement magnitude of the median nerve was found to be less in patients with CTS compared to healthy subjects during most movements, with the exception of wrist extension with fingers extended. Patients with CTS differ from normal subjects with regard to mobility and deformability of the median nerve.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. The elevated pressure in the carpal tunnel causes compression of median nerve. Although the diagnostic criteria for carpal tunnel syndrome are not clear, the diagnosis is based on the patient history and physical examination and may be confirmed by electrodiagnosis with nerve conduction test or ultrasonography. Nonsurgical treatments are generally recommended for early carpal tunnel syndrome and surgical treatments are preferred for failed nonsurgical treatment, however there is controversy regarding the optimal time when the surgery should be performed. Results of surgical treatment are usually satisfactory, however there are also complications after surgical treatment. In order to achieve good results without complications, normal anatomy around the median nerve and its anatomical variations should be thoroughly understood before the operation and careful surgical technique is absolutely required.

Does hereditary neuropathy with liability to pressure palsy predispose to schwannomatosis?

Does hereditary neuropathy with liability to pressure palsy predispose to schwannomatosis?

Upper Extremity Nerve Entrapment Syndromes in Sports

Peripheral nerve entrapment syndromes are difficult diagnoses to make. Symptoms are often vague and mimic other musculoskeletal pathology. Clinicians' best diagnostic tools for entrapment neuropathies are a good history, physical examination, and anatomical knowledge. Neurodiagnostic testing and advanced imaging have some role to play in entrapment neuropathies, but these are not always necessary or helpful. Most entrapment neuropathies resolve with nonoperative treatment. This article will look at upper extremity entrapment neuropathies and review updated literature from the last decade.

Association between Computer Use and Entrapment Neuropathies in the Wrist Region.

There is general consensus in the literature that computer use is often associated with an increased prevalence of hand and wrist disorders. Symptoms may be associated with specific clinical entities such as peripheral nerve entrapment. Motor and sensory nerve conduction velocity and vibration treshold in the hand of computer users have been evaluated in several studies. In this review the relationship between computer work and entrapment neuropathies of median, ulnar and radial nerves in the wrist region will be examined.

Entrapment syndrome of multiple nerves in graft-versus-host disease

Peripheral nerve entrapment syndromes are associated with hereditary neuropathy with liability to pressure palsies and a variety of rheumatic and endocrinological diseases. We report a patient with entrapment syndromes of multiple nerves associated with chronic graft-versus-host-disease (GVHD) after allogeneic hematopoietic stem cell transplantation. Nerve ultrasound, histology, and ultrastructural changes were assessed. The 51-year-old man had developed severe deep dermal sclerosis due to chronic GVHD with a progressive polyneuropathy and entrapment syndromes of multiple nerves. Pre-stenotic enlargement was shown by nerve ultrasound. Histology demonstrated fibrosis of the epineurium with scarce infiltration of macrophages. Electron microscopy demonstrated alterations of the myelin sheaths and marked depletion of normal-sized myelinated nerve fibers. In addition to polyneuropathy, chronic GVHD can be associated with peripheral nerve entrapment syndromes and should be added to the differential diagnosis of compressive neuropathies.

Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up

Chronic groin pain (athletic pubalgia) is a common problem in sports such as football, hockey, cricket, baseball and athletics. Multiple co-existing pathologies are often present which commonly include posterior inguinal canal wall deficiency, conjoint tendinopathy, adductor tendinopathy, osteitis pubis and peripheral nerve entrapment. The mechanism of injury remains unclear but sports that involve either pivoting on a single leg (e.g. kicking) or a sudden change in direction at speed are most often associated with athletic pubalgia. These manoeuvres place large forces across the bony pelvis and its soft tissue supports, accounting for the usual clinical presentation of multiple symptomatic abnormalities forming one pattern of injury. The diagnoses encountered in this series of 100 patients included rectus abdominis muscle atrophy/asymmetry (22), conjoint tendinopathy (16), sports (occult, incipient) hernia (16), groin disruption injury (16), classical hernia (11) traumatic osteitis pubis (5), and avulsion fracture of the pubic bone (4). Surgical management was generally undertaken only after failed conservative therapy of 3-6 months, but some professionals who have physiotherapy during the football season went directly to surgery at the end of the football season. A variety of operations were performed including groin reconstruction (15), open hernia repair with or without mesh (11), sports hernia repair (Gilmore) (7) laparoscopic repair (3), conjoint tendon repair (3) and adductor tenotomy (3). Sixty-six patients were available for follow at an average of 13 years after initial consultation and the combined success rate for both conservative treatment and surgery was 94%. The authors believe that athletic pubalgia or sports hernia should be considered as a 'groin disruption injury', the result of functional instability of the pelvis. The surgical approach is aimed at strengthening the anterior pelvic soft tissues that support and stabilise the symphysis pubis.

Proximal Median Nerve Entrapment Caused by a Distal Biceps Tendon Cyst

A 60-yr-old woman reported severe pain in the proximal part of her left forearm. The pain was also radiating toward the median nerve-innervated areas of the arm, especially during elbow flexion. Ultrasonographic imaging showed a well defined ganglion cyst around the distal biceps tendon close to the median nerve. Under ultrasound guidance, the cyst was aspirated and corticosteroid injection was performed. The patient's complaint improved 1 wk after the injection, and she started to flex her elbow without any pain. This case highlights the role of ultrasonography as a useful adjunctive tool not only to morphologically confirm a peripheral nerve entrapment but also to uncover the possible underlying etiology and to guide precisely during an intervention.

The collateral benefits of having chiropractic available in a public central hospital

Following previous reports on the co-operation between a chiropractor and a central hospital, experiences from the past five years are presented. The objective of this paper is to show that improved management of muscular and skeletal problems within a hospital setting depends on the availability of chiropractic health care as a treatment option. The following pain groups were sampled: 1) sacro-lumbar dysfunction and sciatic leg symptoms, with or without joint dysfunction and sciatica; 2) myo-fascial referred pain syndromes, frequently caused by peripheral nerve entrapment; and 3) tinnitus, dizziness/vertigo, facial pain, ear plug and swallowing difficulties, frequently caused by biomechanical components. A majority of pain patients, after being subjected to traditional conservative treatment, usually over a period of several years, fail to return to work despite younger than average age. The only effective procedures seem to be those of chiropractors. In order to benefit from their particular knowledge, public hospitals need to open their doors to chiropractors. For that to happen, determined hospital administrators are needed.