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What is Nerve Entrapment?

Nerve entrapment, also referred to as pinched nerve or nerve compression, is a medical condition in which a nerve is squeezed, stretched, or compressed by surrounding tissues, such as a muscle, bone, or other tissue. Usually, the nerve is compressed between a ligament and a bone. It usually impacts nerves in a single site, such as your upper or lower limbs. These nerves, which extend from the central nervous system (your brain and spinal cord), are called peripheral nerves. Peripheral nerves connect to sections of your body (such as your hands and feet) that are farther away from the central nervous system. Nerve entrapment can cause neurogenic/neuropathic pain that can either be chronic or acute in nature.

Causes of Nerve Entrapment

Some of the common causes of nerve compression/entrapments are:

  • Prolonged and repeated direct force on the nerve anatomic pathway
  • Pressure from a mass lesion (bony overgrowth, infection, tumor, etc.) around the nerve
  • Weight gain or peripheral edema (thyroid disease, pregnancy)
  • Tissue expansion in a narrow space (carpal tunnel syndrome)

Risk Factors for Nerve Entrapment

Although nerve entrapment typically occurs due to repetitive injuries or motion that cause the ligament and bone to rub or press against the nerve, medical conditions, such as diabetes, hypothyroidism, and rheumatoid arthritis can also contribute to nerve entrapment. These health conditions result in structural changes, decreased blood flow to your nerves, damage to your nerves’ insulation (myelin sheath, which is a layer of tissue that covers the outside of the nerve), and swelling in the surrounding tissue. As a result, your nerves malfunction and become painful.

Symptoms of Nerve Entrapment

Nerve entrapment can typically cause symptoms at the site of the irritated nerve or in fingers or other extremities. These include:

  • Pain
  • Weakness
  • Numbness
  • Tingling
  • Burning
  • Reduced function

Types of Nerve Entrapment

Some of the common types of nerve entrapment include:

  • Carpal tunnel syndrome: Carpal tunnel syndrome is the most common type of nerve entrapment. It involves compression of the median nerve in the wrist.
  • Cubital tunnel syndrome (compression of the ulnar nerve at the elbow)
  • Radial tunnel syndrome (radial nerve compression at the elbow)
  • Herniated disc (spinal nerve compression)
  • Peroneal nerve entrapment (peroneal nerve compression in the knee)
  • Suprascapular nerve entrapment (suprascapular nerve compression in the shoulder)
  • Tarsal tunnel syndrome (compression of the posterior tibial nerve at the heel or sole of the foot)
  • Pudendal nerve entrapment syndrome (compression of the pudendal nerve in your pelvic area)

Diagnosis of Nerve Entrapment

Your physician will review your medical history and perform a thorough physical examination of the area of nerve entrapment to review your symptoms. Your physician may order X-ray and electrodiagnostic tests such as electromyography and nerve conduction studies to confirm the diagnosis. These tests can assist your doctor in determining how well the nerve is functioning and locating the exact place of nerve compression. This will help in overlap diagnosis situations called double crush syndromes in which the patient’s symptoms are related to two or more pathologies in different locations of the nerve pathway. Sometimes, an MRI or CAT scan is required to rule out mass lesions around the nerves.

Treatment for Nerve Entrapment

Treatment may differ based on the cause of the nerve entrapment or compression. The first line of treatment is to put an end to mechanical injury to prevent further damage. This could mean utilizing a brace or other devices to prevent repetitive motion or activities from causing injury or damage to the nerve. It could also mean changing the way one does activities to steer clear of damaging movement in the future. For instance, changing the way a desk is set up and employing an ergonomic keyboard can improve carpal tunnel syndrome that is caused by repetitive typing. Other non-surgical treatments include nonsteroidal anti-inflammatory drugs (NSAIDs) and steroid injections for pain and inflammation, physical therapy to improve strength and flexibility to reduce the pressure on your nerves and avoid future problems, and nerve stimulation, which involves delivering mild electrical pulses into your nerves to block pain signals.

If these conservative treatment modalities are not effective in relieving the symptoms, surgery may be required. Nerve entrapment surgery involves cutting the ligament that is compressing the nerve to broaden the area where the nerve passes. This surgery is extremely effective, and most patients regain complete function with no further pain. Sometimes transposition of the nerve to a better place may also be carried out to prevent the chances of entrapment recurrence. Post surgery, a splint or brace may be used for a specific period of time. Most individuals experience notable improvement in their symptoms shortly post surgery. Nonetheless, in cases of delayed diagnosis conditions and prolonged nerve entrapment situations, full recovery may not be achieved and some symptoms may persist even after surgery.