Chapter 64 Entrapment Neuropathies

CTS is the most common entrapment neuropathy, occurring when the median nerve is compressed by the flexor retinaculum/transverse carpal ligament at the wrist.

Nearly half of patients with chronic rheumatoid arthritis experience entrapment neuropathies at some point in their lifetime.

Elbow flexion and elevating the hand by resting the forearm on the head.

Wearing more supportive shoes and local steroid injections.

Numbness in the index, middle, and radial side of the ring finger, positive Tinel’s sign, positive Phalen’s test, and positive direct median nerve compression test.

The common peroneal nerve.

Local corticosteroid injection.

Compression over the head of the fibula from prolonged leg crossing.

Surgical treatment options.

Compression of the median nerve by the pronator teres muscle at the forearm, resulting in proximal volar forearm pain and numbness in the thumb and index finger.

Treatment includes range of motion and strengthening exercises, avoidance of hyperabduction, botulinum toxin injections, and surgery for severe, refractory symptoms.

Pregnancy, Rheumatoid arthritis, Acromegaly, Glucose (diabetes), Mechanical (overuse), Amyloid, Thyroid (myxedema), Infection (TB, fungal), Crystals (gout, pseudogout).

Common causes include obesity, pregnancy, trauma, surgical injury, tight-fitting clothing, and diabetes mellitus.

A systematic review of clinical diagnosis of carpal tunnel syndrome.

They have a sensitivity of 85% and specificity of 95% for diagnosing CTS.

It refers to wrist-drop resulting from radial nerve entrapment, often occurring while the patient is intoxicated.

They are indicated when the diagnosis is uncertain, to exclude radiculopathy or polyneuropathy, to follow treatment, or before surgery.

Features include dysesthesias, burning or tingling sensations, symptoms worse at night, and muscle weakness or atrophy as late findings.

Avoidance of repetitive wrist motion, cock-up wrist splints, anti-inflammatory medications, and ergonomic evaluation.

It refers to sciatica caused by entrapment of the sciatic nerve by the piriformis muscle, often associated with overuse injuries.

It can occur due to improper positioning during anesthesia, sleeping on the arm, or improperly fitting crutches, leading to prolonged compression of the nerve.

Compression of the ulnar nerve in Guyon’s canal at the wrist, resulting in symptoms similar to cubital tunnel syndrome.

A test for thoracic outlet syndrome performed with the shoulder in abduction and external rotation to assess for symptoms.

Favorable in over 75% of patients.

Lateral stretching and strengthening.

Electrodiagnostic studies are usually normal, and many normal individuals may have false-positive physical examination provocation tests, especially decreased pulse.

Tarsal tunnel syndrome.

Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome.

Characteristic nocturnal dysesthesias (70%), sensory loss, weakness of thumb abduction, and pain radiating into the proximal arm (40%).

Half of the patients.

Diagnosis is usually supported by characteristic symptoms and provocative maneuvers like Tinel’s sign, along with electrodiagnostic studies.

A condition caused by vascular or neurologic compression, often resulting from trauma, repetitive strain, or anatomical abnormalities.

To diagnose thoracic outlet syndrome by palpating the radial pulse while the patient inhales deeply and extends the neck.

Foot drop.

Conditions include polyneuropathies, brachial plexopathy, radiculopathy, Raynaud’s phenomenon, chronic regional pain syndrome, vasculitis, and tendinitis.

Positive Tinel’s sign and positive tourniquet test.

Failure of conservative therapy, lifestyle limiting symptoms, and muscle weakness or atrophy.

Walking on hard surfaces and wearing high heels.

Inflammation and swelling in rheumatoid arthritis can cause pressure on adjacent nerves, leading to entrapment neuropathies.

Patients present with weakness in shoulder abduction and external rotation, and possible atrophy of the supraspinatus muscle.

Ulnar nerve compression at the elbow, leading to paresthesias in the little finger and ulnar side of the ring finger, weakness in grasping, and hypothenar atrophy.

Sensitivity of 50% and specificity of 77%.

It is a condition caused by compression of the lateral cutaneous nerve of the thigh, resulting in burning pain and dysesthesia over the anterolateral thigh.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy.

Morton’s neuroma.

Symptoms include pain over the buttocks radiating down the back of the leg, aggravated by sitting.

Entrapment neuropathies occur when a peripheral nerve is compressed within an enclosed anatomic space.

Increased pressure, stretch, angulation, ischemia, or friction can lead to entrapment neuropathies.

Diminution of the radial pulse and reproduction of symptoms, suggesting thoracic outlet syndrome.

Morton’s intermetatarsal neuroma.

A condition where the anterior interosseous nerve, a motor branch of the median nerve, is compressed, leading to loss of distal thumb and index finger flexion and a characteristic flattened pinch sign.

Most entrapment neuropathies of short duration can be treated conservatively.

Entrapment neuropathies and compartment syndromes.

Conservative treatment of carpal tunnel syndrome.

Entrapment and compressive neuropathies.