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Entrapment Neuropathies Conversion-Gate
Entrapment Neuropathies Conversion-Gate
A proximal level of nerve compression could cause more
distal sites to be susceptible to compression.
The summation of compression along the nerve would result
in alterations of axoplasmic flow
The possibility of a distal site of compression making the
more proximal nerve susceptible to secondary compression: A
reverse double crush.
Systemic diseases such as obesity, diabetes, thyroid disease,
alcoholism, rheumatoid arthritis and neuropatthies lower the
threshold for the occurrence of a nerve compression and alter
axoplasmic transport rendering that nerve more susceptible to
develop compression neuropathy and act as a ‘crush’.
DM is a significant predisposing factor for entrapment
neuropathies .
TN-C(Tenascin-C) expression in the
endoneurium is closely correlated with nerve function.
REF:Vol.10,No.3,2010,Journal of Applied
research
Site of compression essentially same for both Pronator
syndrome(PS) and AIN
PS:Vague volar forearm pain,Median nerve
parasthesias,minimum motor findings
AIN:Pure motor palsy of any or all three 1.FPL,2.FDP
of index and middle fingers,3.PQ.
Surgical indications for nerve decompression include
persistent symptoms for >6 months in patients with PS
or for a minimum of 12 months with no signs of motor
improvement in those with AIN syndrome
MECHANISM
Repititive bending or leaning on elbow for
long periods
Fluid build up in the elbow
Trauma
• All of these cause narrowing and constriction of
the nerve
Aching pain on the inside of elbow
Numbness, tingling ring and index finger
esp when bending the elbow
Weakening of grip,difficulty in finger
coordination,muscle wasting- when more
severe compression
In situ or simple decompression
Incising the aponeurotic arch between the
olecranon and medial epicondyle if
conservative treatment fails
In situ decompression is simple and does not influence the blood
supply of the ulnar nerve
Second, it is also effective because it addresses the primary focus
of the lesion, the cubital tunnel.
Third, it has lower rate of postoperative complications and more
opportunities for quicker rehabilitations
Wrist splints
Surgical
decompression from failed non-op
mgmt., especially with structural lesions
such as hook of hamate fracture
Radial nerve entrapment at one of 5 sites
Anatomy- posterior cord to emerge between
long and lateral heads of triceps, spiral
groove of humerus proceeding medially to
laterally to emerge between brachialis and
brachioradialis on lateral elbow to enter the
radial tunnel
Susceptible:Racquet sports, rowing and wt.
lifting
Sensory and motor complaints, although
typically less weakness than with Posterior
interosseous Nerve entrapment
Hydrocortisone
Sciatica refers to irritation of the sciatic
Piriformis syndrome (false
nerve, that arises from nerve roots in the
sciatica)because instead of actual nerve
lumbar spine. The most common cause
irritation, it is caused by referral pain.
of “true” sciatica is compression of one
caused by tight knots of contraction in the
or more of its component nerve roots
piriformis muscle,
due to disc herniation or spinal
degeneration in the lower lumbar region
Duringdelivery as a result of compression of
the nerve between the head of the fetus and
the bony structures of the pelvis,
As a consequence of compression of the
nerve between a tumor and the bony pelvis.
in the obturator canal during surgery or with
total hip arthroplasties.
Malposition of the lower limb for prolonged
periods, entrapment in the adductor magnus
in athletes,
Clinical:
difficulty with ambulation and the
development of an unstable leg.