Entrapment neuropathy is a term describing a type of neuropathy that is rather commonly encountered in clinical practice (carpal tunnel syndrome is one of the examples) and results from either compression, traction or structural impairment of the nerve [1] [2] [3]. As the nerve becomes compressed or "entrapped" in tissues after trauma or some other form of injury, the blood supply to the nerve is diminished, eventually causing edema, ischemia, necrosis and death of neuronal tissue if the structural deformity is not repaired promptly [4] [5]. During this process, typical symptoms of neuronal injury arise, such as pain, paresthesia, and numbness [1]. Depending on the affected nerve, both sensory and motor deficits can be observed. For example, deltoid weakness indicates axillary nerve entrapment; restriction of wrist flexion is present in the setting of median nerve compression, whereas loss of sensation in the dorsal proximal areas of the index finger, middle finger and the thumb suggests radial nerve entrapment [1] [2]. It must be noted that several nerves could be entrapped at more than one anatomical location, which is why recognizing associated signs and symptoms is pivotal for identifying the affected nerve [1] [2] [6]. The appearance of symptoms can be abrupt or slowly progressive [1].

• Pain

  As her right-side pain around the MCN -EN with severe trigger pain recurred we performed microscopic right MCN neurolysis under local anesthesia. This led to dramatic improvement of her LBP and leg pain and the numbness improved. [ncbi.nlm.nih.gov]

• Surgical Procedure

  As 3 local anesthetic pain blocks (at the trigger point, 7 cm left of the L5 spine process and just above the iliac crest) were successful for 3 weeks each, a surgical procedure was performed. [ncbi.nlm.nih.gov]

  Discussion Various surgical procedures have been described for the treatment of cubital tunnel syndrome. [scielo.isciii.es]

  The surgical procedure required depends on the type of nerve compression syndrome, the degree of compression, and the nerves and structures affected. Each procedure has its risks and benefits. [healthline.com]

• Inflammation

  Once an accurate diagnosis is obtained, treatment is aimed at reducing external pressure, minimizing inflammation, correcting any causative foot and ankle deformities, and ultimately releasing any constrictive tissues. [ncbi.nlm.nih.gov]

  An entrapment point occurs in the course of a nerve where the anatomic configuration may cause constriction of the nerve, or, if trauma has occurred to the area, the particular anatomic disposition will maintain the nerve in a state of inflammation. [nejm.org]

  Medication Medication can help relieve symptoms of nerve compression syndrome such as pain and inflammation. The type of medication prescribed depends on the severity of symptoms. [healthline.com]

• Asymptomatic

  MATERIALS AND METHODS: One hundred consecutive 1.5-T knee MR studies of 97 asymptomatic patients were retrospectively reviewed by two observers in consensus for, first, normal anatomy of the distal biceps femoris muscle; second, anatomic variations of [ncbi.nlm.nih.gov]

  It involves acute sensory neuropathy with severe lower extremity pain and chronic sensorimotor neuropathy that is asymptomatic in up to 50% of cases, insidious, and which carries autonomic dysfunction and late complications of ulceration and amputation [spineuniverse.com]

• Falling

  These fall into four anatomical regions of the body: cranial, upper limb, truncal, and lower limb territories. [mayoclinic.pure.elsevier.com]

  Without proper balance, you are at risk for falling, which may cause a broken bone, such as a wrist or a hip. Is neurosensory testing necessary? Yes. [thefootanklecenter.com]

  Due to fall-fractures, weird loading of metatarsals Bursa locations are where the neuromas are gonna occur Trauma ( fall from a height, stepping on a sharp object, etc.) can result with development of a *neuroma Fracture of a metatarsal can cause altered [quizlet.com]

  Gait ataxia, with difficulty walking or frequent falls, is observed. [spineuniverse.com]

• Nausea

  Most patients also have concomitant various pseudo-visceral complains, anorexia, nausea, bloating, altered defecation, (pseudo visceral complaints). Asking the patient to tense his/her abdominal wall will elicit the pain (positive Carnett's test). [orpha.net]

  The signs and symptoms of autonomic neuropathy include the following: Urinary bladder conditions: bladder incontinence or urine retention Gastrointestinal tract : dysphagia, abdominal pain, nausea, vomiting, malabsorption, fecal incontinence, gastroparesis [en.wikipedia.org]

• Thrombosis

  The pathology of PAES is believed to be progressive, with arterial thrombosis occurring in some individuals as a natural progression of the disease process. [ncbi.nlm.nih.gov]

  Ulnar artery aneurysms or thrombosis at the wrist. Investigations Blood tests may be appropriate to rule out various disorders causing neuropathy - eg, anaemia, diabetes mellitus, hypothyroidism and rheumatoid arthritis. [patient.info]

  Treatment and prognosis Acute limb-threatening thrombosis requires urgent bypass surgery. Intermittent occlusion can usually be cured with the release of the popliteal artery alone or with saphenous vein bypass 2. [radiopaedia.org]

  • Zone 3: ulnar artery thrombosis OTHER CAUSES: • Malunited fracture of fourth/fifth metacarpal. • Anomalous muscles • Occupational trauma 30. [slideshare.net]

• Vascular Disease

  disease from extrinsic compression. [vasculardiseasemanagement.com]

  Popliteal artery entrapment syndrome (PAES) is a rare vascular disease that affects the legs of some young athletes. [my.clevelandclinic.org]

  Metallic stents are commonly used to treat vascular disease that develops due to atherosclerosis (hardening of the arteries). In most cases, patients with PAES have a normal artery, and a stent placement is not durable or successful. [hopkinsmedicine.org]

• Hypertension

  "Fundus lesions in malignant hypertension. V. Hypertensive optic neuropathy". Ophthalmology. 93 (1): 74–87. doi : 10.1016/s0161-6420(86)33773-4. PMID 3951818. / ^ Kawana T, Yamamoto H, Izumi H (December 1987). [en.wikipedia.org]

• Ulcer

  Risks associated with diabetic neuropathy: Ulcers – One in six people with diabetes will develop an ulcer on their foot during their lifetime. Amputations – One in six people who develop an ulcer will require an amputation. [thefootanklecenter.com]

  […] earliest indication of the disorder may include: Pain Prickling and tingling sensation Numbness Muscle weakness For more chronic entrapment neuropathies, symptoms may include: Dry, thin, hairless skin Ridged, thickened, cracked nails Recurrent skin ulcerations [mdmercy.com]

  It involves acute sensory neuropathy with severe lower extremity pain and chronic sensorimotor neuropathy that is asymptomatic in up to 50% of cases, insidious, and which carries autonomic dysfunction and late complications of ulceration and amputation [spineuniverse.com]

  Recurrent skin ulcers. Treatment for Entrapment Neuropathy or Nerve Compression Syndrome As a rule the underlying medical condition that is the cause of entrapment neuropathy needs to be treated first. [epainassist.com]

• Visual Impairment

  The authors report on the case of a 14-year-old boy who presented with bilateral visual impairment due to optic canal stenosis caused by hyperplasia of the bone marrow arising from anemia. [ncbi.nlm.nih.gov]

• Osteophyte

  Medial trochlear lip osteophytes were not found in the studies of normal elbows but were noted in 20% of ulnar nerve entrapment cases. [ncbi.nlm.nih.gov]

  TUNNEL Bony abnormalities of the carpal bones Acromegaly • INCREASE IN CONTENTS OF CANAL Forearm & wrist fractures (colle’s, scaphoid) Dislocations & subluxations (scaphoid rotary subluxation, lunate volar dislocation) Post traumatic arthritis (osteophytes [slideshare.net]

  The nerve may be directly compressed along its course by abnormal anatomy that results from fractures, synovitis from rheumatoid arthritis, ganglion cysts, tumors, osteophytes, or aberrant muscles. [rheumatologynetwork.com]

  The nerve can become entrapped in the cubital tunnel of the elbow during heavy manual work or following a previous poorly healed supracondylar fracture of the humerus or due to osteophytic encroachment in osteoarthritis. [patient.info]

  In cases of spontaneous nerve subluxation or cases of excessive scarring or osteophytes formation within the cubital tunnel, the authors’ believe that the nerve should be anteriorly transposed. [emedicine.medscape.com]

• Calf Pain

  Case A 38-year-old female competitive ‘ironman triathlete’ athlete with no medical history presented with exertional left calf pain. On examination, the patient had a full complement of lower-limb pulses. [bjsm.bmj.com]

  […] and other pain syndromes of the leg. [eorif.com]

  Due to an abnormal course of the popliteal artery and the calf muscle group, the artery can be compressed and reduce blood flow. The consequence of reduced flow from calf contraction is immediate and leads to cramping and calf pain during exercise. [hopkinsmedicine.org]

  Fabre T, Montero C, Gaujard E, Gervais-Dellion F, Durandeau A: Chronic calf pain in athletes due to sural nerve entrapment: A report of 18 cases. Am J Sports Med 2000;28(5):679–682. 59. [journals.lww.com]

• Foot Pain

  […] squeezing it -Pain radiates into toes and may radiate transversely across metatarsal heads -Pain radiates to *back of the leg -Pain so severe that the pt stops walking, removes shoe, & * massages the foot which alleviates the pain -*No nocturnal pain [quizlet.com]

  Pain on the inside of the foot must be distinguished from other causes of pain, for example, a Morton’s neuroma, plantar fasciitis, heel spurs, arthritis or bone spurs, and early Charcot’s neuroarthropathy. [care.diabetesjournals.org]

  Patients typically report diffuse pain along the medial ankle and plantar foot. The pain may be exacerbated by activity and alleviated by rest. Symptoms are often present at night. [journals.lww.com]

  Patients most commonly report burning pain and paresthesias along the plantar aspect of the foot and toes that worsen with activity. [pubs.rsna.org]

• Lordosis

  The lumbosacral radiographies did not show any significant difference in either the degree of lumbar spinal lordosis or the intercristal line levels among the three groups. [ncbi.nlm.nih.gov]

• Paresthesia

  Entrapment neuropathy is a rather common type of nerve injury in which mechanical factors lead to compression of the nerve and subsequent appearance of pain, paresthesias, and associated muscle abnormalities. [symptoma.com]

  When evaluating patients with unilateral leg pain and paresthesias, one should consider the possibility of entrapment of peripheral nerve. Electrodiagnostic studies are helpful in establishing the diagnosis. [ncbi.nlm.nih.gov]

• Foot Drop

  An entrapment neuropathy of the superficial peroneal can cause foot drop by extending the nerve, and placing traction on the L5 nerve root. This will result in the expected fibrillation of the foot extensor muscles. [tonymorris.github.io]

  Four patients had classical rheumatoid arthritis, while foot-drop developed in one man after trauma to the knee. In all five patients, a painful palpable enlargement in the popliteal area became most symptomatic with the [jamanetwork.com]

  In the leg with peroneal neuropathy, this might manifest as foot drop, the inability to hold the foot up when walking. With foot drop, the foot will slap on the ground or even “catch”: the ground when the foot swings through when walking. [neckandback.com]

  Symptoms can include: numbness, tingling, muscle weakness pain in the limbs loss of sensation in the hand (similar to carpal tunnel syndrome ) muscle weakness, making it difficult to lift the front part of the foot (foot drop) or the wrist (wrist drop [nhs.uk]

  This leads to a condition called " foot drop ," in which it becomes difficult to lift the foot. Neuropathy can affect nerves that control muscle movement (motor nerves) and those that detect sensations such as coldness or pain (sensory nerves). [webmd.com]

• Burning Sensation

  Pain is less common than tingling or numbness as a symptom of nerve entrapment, although a burning sensation, if it occurs, may (subjectively) be classified as pain. [en.wikipedia.org]

• Numbness of the Hand

  Characteristic clinical symptoms of carpal tunnel syndrome are pain and numbness in the hand, which often aggravate at night (nocturnal acroparesthesia), the latter believed to be caused by nerve ischaemia. [ncbi.nlm.nih.gov]

  Common forms of entrapment neuropathy are carpal tunnel syndrome and cubital tunnel syndrome, which affect nerves in the wrists and elbows, causing pain and numbness in the hands. [wisegeek.com]

  The person may awaken at night with numbness in their hand or discover that when they perform activities like using a hair dryer, the numbness is more noticeable. In time, carpal tunnel injuries can weaken the muscles in the hand. [webmd.com]

• Areflexia

  […] combination of greater and lesser occipital neuralgia Migraines Cluster headaches Peripheral neuropathy related to Sj ö gren ’ s syndrome may involve: Burning pain, numbness or weakness from distal to proximal, large- or small-fiber neuropathy, and areflexia [spineuniverse.com]

A delayed diagnosis of entrapment neuropathy and nerve compression may lead to irreversible neuronal injury and cause a significant impairment in daily life, thus early recognition of this clinical entity is of absolute necessity [3] [6]. One of the first steps toward the diagnosis is a detailed patient history that will determine the duration of symptoms and their severity, followed by a thorough physical examination, perhaps the pivotal part of the diagnostic workup [1] [6]. Depending on the cause and location of symptoms, a complete motor evaluation of muscle groups and the sensorium in the areas where the patient reports pain, paresthesias, or numbness, is the mainstay in revealing which nerve is injured [1] [6]. A presumptive diagnosis might be made solely on clinical findings, but imaging and electrophysiologic studies are highly useful in confirming entrapment neuropathy. Plain radiography, although important in delineating skeletal injuries as potential causes, is of no use in assessing nervous tissues [1]. For this reason, ultrasonography (US) and magnetic resonance imaging (MRI) are recommended but are not equally effective for all anatomical sites [1] [2] [6] [7]. A hypoechogenic appearance of the nerve, as well as edema, thickening, and fatty atrophy of the muscles supplied by the injured nerve, are frequent findings on US, whereas swelling and hyperintensity are seen on MRI studies [1] [4] [7]. Conversely, electromyography (EMG) and nerve conduction studies are often used in the setting of peripheral nerve injury and provide important clues in discerning between peripheral and central nerve injuries [1] [6].

Below, we describe the decision making process for the diagnosis and treatment of his pudendal neuropathy. [ncbi.nlm.nih.gov]

Surgical treatment of superior cluneal nerve entrapment neuropathy. J Neurosurg Spine. 2013. 19: 71-5 [surgicalneurologyint.com]

Each of these groups of mononeuropathies has its own ensemble of epidemiologic patterns, clinical presentations, laboratory and radiologic findings, differential diagnosis, management principles and prognosis. [mayoclinic.pure.elsevier.com]

EMG and nerve conduction studies are typically performed to diagnose the extent and distribution of the damage, and to help with prognosis for recovery. [en.wikipedia.org]

However, the little research that has been done to determine the prognosis for individuals who have undergone surgery has focused on the patency rate of the arteries after surgery and the presence or absence of complications. [ncbi.nlm.nih.gov]

Prognosis [ 11 ] Duration of entrapment and severity of numbness and muscle weakness are important factors in prognosis. Mild cases may resolve without treatment. With early appropriate decompression the result should be a return to normal function. [patient.info]

Prognosis Diagnostic delay is common; untreated ACNES can lead to functional disability and reduced quality of life resulting in high medical health care costs, highlighting the importance of the awareness of ACNES among medical professionals. [orpha.net]

Lastly, the etiological structure may be the descriptor, such as pronator teres syndrome. [fadavispt.mhmedical.com]

CONCLUSION: This prospective study depicts the etiologic factors, ultrasonographic features and treatment protocol of MSCNE which is usually an underestimated cause of the low-back pain. [ncbi.nlm.nih.gov]

Common etiologies include posttraumatic fibrosis due to fracture, tenosynovitis, ganglion cysts (Figure 20), space-occupying lesions, and dilated or tortuous veins. [hindawi.com]

Each of these groups of mononeuropathies has its own ensemble of epidemiologic patterns, clinical presentations, laboratory and radiologic findings, differential diagnosis, management principles and prognosis. [mayoclinic.pure.elsevier.com]

Popliteal artery ICD-10 codes A- initial encounter D- subsequent encounter S- sequela Popliteal Artery Entrapment Syndrome ICD-9 904.4 Injury to blood vessels of lower extremity; popliteal blood vessels Popliteal Artery Entrapment Syndrome Etiology / Epidemiology [eorif.com]

Summary Epidemiology Around 20% of patients with chronic abdominal pain have abdominal wall pain, which is often caused by ACNES. The prevalence in patients alleged to have functional abdominal pain is estimated to be 3-4%. [orpha.net]

EPIDEMIOLOGY The estimated incidence of abdominal wall pain is 1 in 1800 individuals [ 8 ]. [uptodate.com]

Therefore, cumulatively, only 69 of our 12,736 cases of CTS and UN-E satisfied the pathophysiologic and one of the anatomic requirements of the DCH. [n.neurology.org]

Published on Dec 5, 2016 Annina Schmid is a Physiotherapist and associate professor whose research focusses on advancing our understanding of the pathophysiology of entrapment neuropathies to ultimately improve management of these patients. [youtube.com]

|Subscribe on iTunes| Session 36 – Moving Beyond ‘Trapped Nerves’ – Entrapment Neuropathy with Annina Schmid Annina Schmid is a Physiotherapist and associate professor whose research focusses on advancing our understanding of the pathophysiology of entrapment [chewshealth.co.uk]

The pathophysiological changes following nerve compression 8 – 21 are dependent on the degree, rate, and duration of compression. [clinicalgate.com]

Pathophysiology of nerve compression. Hand Clin. 18(2): 231-41. ↑ Tapadia, M., Mozaffar, T., & Gupta, R. (2010). Compression neuropathies of the upper extremity: update on pathophysiology, classification, and elecrodiagnostic findings. [physio-pedia.com]

A thorough understanding of the anatomy of these nerves can prevent stapling in the areas of danger and thus greatly reduce the incidence of this complication. [ncbi.nlm.nih.gov]

Prevention Changing physical activities can often help reduce the injury, when nerve entrapment injuries are caught early. [minneapolisclinic.com]

Home remedies and prevention There are lots of things a person who has ulnar nerve entrapment can do at home to promote healing and recovery. These same steps can also prevent ulnar nerve entrapment from recurring or happening in the first place. [medicalnewstoday.com]

My staff and I at the Nebraska Hand & Shoulder Institute, P.C. believe that prevention and elimination of painful or debilitating conditions of the upper and lower extremities can consistently be achieved. [carpaltunnelrelief.net]

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2. Miller TT, Reinus WR. Nerve entrapment syndromes of the elbow, forearm, and wrist. AJR Am J Roentgenol. 2010;195(3):585-594.
3. Choi S-J, Ahn JH, Ryu DS, et al. Ultrasonography for nerve compression syndromes of the upper extremity. Ultrasonography. 2015;34(4):275-291.
4. Deniel A, Causeret A, Moser T, Rolland Y, Dréano T, Guillin R. Entrapment and traumatic neuropathies of the elbow and hand: An imaging approach. Diagn Interv Imaging. 2015;96(12):1261-1278.
5. Kobayashi S, Meir A, Baba H, Uchida K, Hayakawa K. Imaging of intraneural edema by using gadolinium-enhanced MR imaging: experimental compression injury. AJNR Am J Neuroradiol. 2005;26(4):973-980.
6. Fox IK, Mackinnon SE. Adult Peripheral Nerve Disorders—Nerve Entrapment, Repair, Transfer and Brachial Plexus Disorders. Plast Reconstr Surg. 2011;127(5):10.1097/PRS.0b013e31820cf556.
7. Lawande AD, Warrier SS, Joshi MS. Role of ultrasound in evaluation of peripheral nerves. Indian J Radiol Imaging. 2014;24(3):254-258.