Nerve compression syndromes is a medical emergency and chronic compressive or entrapment and non-compressive neuropathic condition caused by direct, or indirect pressure on a nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression (by a herniated disc, for example) of the hand present with various symptoms that correspond and referring to the nerve involved and its anatomic distribution. There are three nerves and their corresponding branches that provide sensory and motor innervation to the hand that include the median, ulnar, and radial. An understanding of the anatomy and distribution of these nerves is paramount in distinguishing the various signs, and symptoms in nerve compression syndromes.[rx][rx]
Types of Nerve Compression Syndromes
There are several different types of nerve compression syndromes are found. Each one affects a different peripheral nerve and deep nerve. The following are some of the most common types of nerve compression syndromes:
Carpal tunnel syndrome
Carpal tunnel syndrome is the most common and 1st type of nerve compression syndrome. It occurs when the median nerve is compressed at the wrist and arms, and cervical reason. The median nerve extends from the upper arm to the thumb to the phalanges. At the wrist, it passes through a structure called the carpal tunnel in where are nerve causes problems. Excess pressure on the wrist may cause swelling, tenderness which can lead to carpal tunnel syndrome.
Cubital tunnel syndrome
Cubital tunnel syndrome is the second-most common type of nerve compression syndrome. Also known as ulnar neuropathy or ulnar nerve entrapment at the elbow joint, it occurs when the ulnar nerve is compressed at the elbow joint. The ulnar nerve is responsible for the sensation in peripheral, and deep muscle that you get when you hit your funny bone. It passes close to the skin at the elbow to phalanges. Putting too much pressure on the elbow and spinal cord in cervical Rajon may cause swelling, which can lead to ulnar tunnel syndrome.
Other types
Others nerve compression syndrome is most likely to occur at sites where nerves pass through tunnel-like structures in maximum cases. The following are some rarer types of nerve compression syndrome are following
- Suprascapular nerve compression syndrome – This affects the suprascapular nerve and can cause symptoms in shoulder pain, paresthesia.
- Guyon’s canal syndrome – This syndrome affects the ulnar nerve and can impact function in pain, swelling, tenderness in the hand.
- Meralgia paresthetica – This affects the lateral cutaneous nerve injury, compression and can cause symptoms in the outer thigh.
- Radial nerve compression syndrome – This syndrome affects the radial nerve most often, which extends the length of the arm. It can impact wrist, hand, and finger function.
Upper limb
| nerve | location | usually referred to as |
|---|---|---|
| Median | carpal tunnel | carpal tunnel syndrome |
| Median (anterior interosseous) | proximal forearm | anterior interosseous syndrome |
| Median | pronator teres | pronator teres syndrome |
| Median | ligament of Struthers | Ligament of Struthers syndrome |
| Ulnar | cubital tunnel | Cubital tunnel syndrome |
| Ulnar | Guyon’s canal | Guyon’s canal syndrome |
| Radial | axilla | Radial nerve compression |
| Radial | spiral groove | Radial nerve compression |
| Radial (Posterior interosseous) | proximal forearm | posterior interosseous nerve entrapment |
| Radial (Superficial radial) | distal forearm | Wartenberg’s Syndrome |
| Suprascapular | Suprascapular canal | suprascapular nerve entrapment |
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Lower limb, abdomen, and pelvis
| nerve | location | usually referred to as |
|---|---|---|
| Common peroneal | fibular neck | peroneal nerve compression |
| Tibial | tarsal tunnel | tarsal tunnel syndrome |
| Saphenous | The roof of Adductor canal | Saphenous nerve entrapment syndrome |
| The lateral cutaneous nerve of thigh | inguinal ligament | meralgia paraesthetica |
| Sciatic | piriformis | piriformis syndrome [not always due to entrapment] |
| Iliohypogastric | lower abdomen | iliohypogastric nerve entrapment |
| Obturator | obturator canal | obturator nerve entrapment |
| Pudendal | pelvis | pudendal nerve entrapment |
| Abdominal cutaneous nerves | abdominal wall | anterior cutaneous nerve entrapment syndrome |
Causes of Nerve Compression Syndromes
General considerations are listed below along with differentials specific to each syndrome discussed[8][12][15]:
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Peri-articular – Tenosynovitis including De Quervain tenosynovitis, pigmented villonodular tenosynovitis, acute calcific peri-arthritis and ganglion
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Bone lesions – Fractures, neoplasms, infection, osteonecrosis like Kienbock disease (avascular necrosis of the lunate bone) and Preiser disease (scaphoid bone)
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Neurologic – Nerve entrapment syndromes, particularly carpal tunnel syndrome and ulnar nerve entrapment in the Guyon canal.
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Vascular – Scleroderma and occupational vibration syndromes
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Referred pain – Cervical spine disorders and reflex sympathetic osteodystrophy
Carpal Tunnel Syndrome:
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Anterior interosseous compressive neuropathy
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Flexor tendonitis
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Pronator syndrome
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Wrist osteoarthritis
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Crystalline arthritis
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Bursitis
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Tendinitis
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Hemochromatosis
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Avascular necrosis
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Radiculopathy
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Other soft-tissue conditions
General considerations:
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Brachial plexopathy
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Cervical radiculopathy or myelopathy
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Compartment syndrome
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Fibromyalgia
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Motor neuron disease, e.g., amyotrophic lateral sclerosis
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Thoracic outlet syndrome
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Vasculitis and Raynaud phenomenon
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Vitamin deficiency
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Cubital tunnel syndrome
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Extensor carpi ulnaris tendonitis
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The hook of hamate fracture
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The triangular fibrocartilage complex (TFCC) tear
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De Quervain tenosynovitis
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Intersection syndrome
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Lateral antebrachial cutaneous nerve neuritis
Symptoms of Nerve Compression Syndromes
Some common symptoms include:
- redness, swelling, and inflammation
- aches and pain
- tingling or numbness
- muscle weakness
- reduced flexibility
- difficulty with certain movements
Shoulders
Nerve compression symptoms in the neck can cause pain to radiate out to the shoulders and arms. A doctor may refer to this type of nerve compression neuropathy as cervical radiculopathy or a pinched nerve.
Symptoms of cervical radiculopathy include
- a sharp or burning pain in the neck, shoulder, or arm and forearm
- additional pain when turning the head or extending the neck fell intense pain.
- a tingling sensation in the hand and fingers with radiating
- muscle weakness, spasm in the hand, arm, or shoulder
- a loss of sensation and paresthesia in the hand, arm, or shoulder
Elbows
Nerve compression neuropathy in the elbows is known as cubital tunnel syndrome firstly. Cubital tunnel syndrome is a compression of the ulnar nerve in the elbow and forearm, which runs from the neck through to the hand and finger.
The symptoms of cubital tunnel syndrome may be following
- numbness or tingling, itching in the hand and fingers, particularly the ring finger and little finger
- weakness in the hand, muscle spasm with spasticity.
- difficulty with finger coordination in most common cases, such as when typing or playing an instrument
- in severe cases, muscle wasting in the hand are worse
Hands
Carpal tunnel syndrome is the most common type of nerve compression in the hand and phalange. Carpal tunnel syndrome is a compression of the median nerve, which runs from the upper arm through to the hand.
Carpal tunnel syndrome is the most common among females and older adults. Symptoms are following
- numbness or tingling, paresthesia in the hand and arm
- pain in the hand and arm intense, which may worsen at night
- shock-like or burning sensations in the thumb and fingers and upper arm
- weakness or clumsiness in the hand, which may make people drop things
- difficulty gripping or grasping with the hand, counting money, writing, typing
- People may find that shaking the hand relieves the symptoms quickly
Diagnosis of Nerve Compression Syndromes
Physical examination includes inspection, palpation, range of motion, and special tests.
- Inspection – Swelling, and deformities are the two important findings associated with pain, paresthesia, and arthritis. Regarding pain, swelling, it is important to identify between a joint effusion from tenosynovitis or a localized mass. Arthritis associate pain usually produces a diffuse circumferential swelling. It can also result in instability, and weakness with dorsal subluxation of the ulnar head, which causes “piano key” like movement with downward pressure hand.
- Palpation – Palpation helps in identifying the specific area affected by the underlying pathology abnormality. The hand is best palpated in slight flexion and feeling the dorsal surface of the wrist with the thumb when supporting the hand with the fingers of both hands. Dorsal instability is a major sign of joint effusion and instability. Instability can be tested by looking for some specific conditions of pressure from one hand placed on one side of the joint to the second hand placed on the opposite side.
- Range of Motion – your doctors’ advice to test the active range of motion first. They should attempt if there is any limitation or range of motion to look for any improvement. The range of motion tested at the wrists is flexion, extension, radial, and ulnar deviation is the maximum criteria of pain. The normal range of flexion in the wrist joints is 65 to 80 degrees of flexion, 55 to 75 degrees of extension, 30-45 degrees of ulnar deviation, and 15 to 25 degrees of radial deviation.
Other findings in the physical examination can include
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Froment sign – Your doctor performs is performed by having the patient attempt to hold a piece of paper between the thumb and index finger. The examiner then attempts to pull the paper part out of the patient’s fingers. A positive result is seen with compensatory interphalangeal joint hyperflexion may be found by the flexor pollicis longus, which is innervated by the anterior interosseous nerve. This is to compensate for the loss of thumb adduction also from the weakness of the abductor pollicis longus muscle.
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Wartenberg sign – which presents as an abduction posturing problem of the little finger, due to the weakness of the adducting palmar interosseous muscle.
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Tinel sign – Your doctor’s gentle tapping over the course of the superficial branch of the radial nerve resulting in the reproduction of pain and/or paresthesias. This is the most common finding. A positive result is when there is an electrical shock sensation in the median nerve distribution in the hand.
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Dellon test – THis test is performed by your doctors with active, forceful hyperpronation of the forearm with flexion and ulnar deviation of the wrist, which reproduces symptoms of pain, swelling, pain. This test is performed by your doctor with active, forceful hyperpronation of the forearm muscle with flexion and ulnar deviation of the wrist, which reproduces symptoms of pain, swelling, tenderness.
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Durkan test – Your doctors performed by pressing the examiner’s thumbs over the carpal tunnel and holding by pressuring for 30 seconds. A positive test occurs with the onset of pain or paresthesia in the median nerve distribution.
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Flick sign – History of your doctor of awakening with symptoms and shaking the hand to provide relief. This sign has the maximum specificity in the diagnosis of carpal tunnel syndrome and pain.[rx]
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Finkelstein test – Your doctors performed by asking the patient to make a fist around the thumb and ulnar deviate the wrist joint. A positive test is indicative of De Quervain’s tenosynovitis problem (tendonitis of the first dorsal compartment). This test may be positive as the neuropathy, and first dorsal compartment tenosynovitis may coexist with pain.
Imaging Test
Multiple diagnostic modalities may be utilized to evaluate for nerve compression syndromes, and they can include[1][7][14][rx]:
- Laboratory tests – Leukocytosis supports the possibility of infection and pain, swelling. Cultures of blood, urine, stools or other possible primary sites of infection are mandatory when inflammation is being considered. Elevated or high inflammatory markers like ESR or CRP, although nonspecific, suggest an infectious or inflammatory process.
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Electrodiagnostic studies – Electromyography and nerve conduction test studies help to localize the nerve problem involved as well as where along the course of the nerve it is affected. Additionally, testing can serve as a baseline for comparison with the future during the course of treatment. It is important to note that normal electrodiagnostic studies do not identify disease, and clinical correlation should include the patient’s history and physical examination findings.
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Plain radiographs – May be useful during instances where there is a history of trauma, injury, arthritis or there is suspicion of a fracture. It can also help to investigate cases of osteoarthritis, bony prominences or osteophytes, and the presence of orthopedic problems that could compress nerves.
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Magnetic Resonance Imaging (MRI) – Can be useful in the identification of ganglion cysts, synovial or muscular hypertrophy, edema, swelling, vascular disease, as well as nerve changes. The cross-sectional investigation and space available for the nerve can also be compare and measures and compared to accepted normal values.
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Ultrasound – The use of nerve ultrasonography has increased recently in this case. It can measure the cross-sectional area and the longitudinal diameter of the nerve, muscle, tendon, ligament. Ultrasound may also evaluate the presence of local edema, swelling. Additionally, ultrasound may help identified between different causes of wrist pain that can include tendonitis or osteoarthritis and stiffness.
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Serologic studies – There are no blood tests used to specifically support the diagnosis of nerve compression, demyelination but the use of these tests may be necessary for medical conditions that can either increase nerve compression or can decrease their symptoms. Some of the most frequently find conditions include diabetes and hypothyroidism. The assessment of a patient’s fasting blood glucose, hemoglobin A1c, or thyroid function tests may be helpful in the general management of the patient. Other conditions that could mimic nerve compression include deficiency of vitamin B12 or folate, vasculitides, and fibromyalgia.
Treatment of Nerve Compression Syndromes
- Analgesics – It is basically paracetamol with prescription-strength drugs that relieve pain but not inflammation.
- Muscle Relaxants – These medications provide relief from spinal muscle spasms. Muscle relaxants, such as baclofen, tolperisone, eperisone, methocarbamol, carisoprodol, and cyclobenzaprine, may be prescribed to control muscle spasms.
- Neuropathic Agents – Drugs(pregabalin & gabapentin) that address neuropathic—or nerve-related—pain. This includes paresthesia, radiating pain with numbness, diabetic neuropathy pain, myalgia, burning, numbness, and tingling sensation
- Opioids – Also known as narcotics, these medications are intense pain relievers that should only be used under a doctor’s careful supervision.
- NSAIDs – Prescription-strength drugs that reduce both pain and inflammation. Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include mainly or first choice etodolac, then aceclofenac, etoricoxib, ibuprofen, and naproxen.
- Calcium & vitamin D3 – To improve bone health and healing fracture with associate muscle and bones problem. As a general rule, men and women age 50 and older should consume 1,200 milligrams of calcium a day, and 600 international units of vitamin D a day.
- Glucosamine & Diacerein, Chondroitin sulfate – can be used to tightening the loose tendon, cartilage, ligament, and cartilage, ligament regenerates cartilage or inhabits the further degeneration of cartilage, ligament. The dosage of glucosamine is 15oo mg per day in divided dosage and chondroitin sulfate approximately 500mg per day in different dosage may be taken.[rx]
- Vitamin B1, B6, and B12 – It is essential for neuropathic pain management, pernicious anemia, with vitamin b complex deficiency pain, paresthesia, numbness, itching with diabetic neuropathy pain, myalgia, etc.
- Dietary supplement – to remove general weakness & improved health.
- Antidepressants – A drug that blocks pain messages from your brain and boosts the effects of endorphins (your body’s natural painkillers).
Home remedies
The following home remedies and exercise may prevent or relieve symptoms of nerve compression syndrome
- icing pain, paresthesia the affected area for 10 to 15 minutes
- applying topical creams, patch, gel, ointment such as menthol
- stopping activities that cause pain usually that types work elevated pain
- taking regular breaks when doing repetitive tasks, possible
- wearing a splint or brace, according to advised your doctor
- using relaxation exercises regularly
- keeping the affected area warm by compressing the hot pot
- elevating the affected area if possible horizontally above the heart
- doing stretches and exercises to improve muscle strength and flexibility
References
