Reappraising entrapment neuropathies — Mechanisms, diagnosis and management
Entrapment neuropathies (such as carpal tunnel syndrome, piriformis syndrome, meralgia paraesthetica, etc.) are thought to be driven by local peripheral nerve mechanisms, however, they do not always follow a clear dermatomal, myotomal or sclerotomal pattern. This masterclass reviews the local, peripheral and central mechanisms and their consequence in diagnosis and treatment.
Nerve compression causes neuroinflammation (via glial and immune cells activation and inflammatory mediators) in the peripheral nerve, dorsal root ganglion and spinal chord; it also induces glial cells activation in the midbrain and thalamus, and cortical reorganisation, such as in the somatosensory cortex. These mechanisms can explain the wide spread and variety of symptoms.
Clinical (symptoms, neurological examination, provocation tests, neurodynamics, palpation) and diagnostic (electrodiagnostics, quantitative sensory testing, imaging) tests are available but lack validity.
Conservative treatment aims at normalising peripheral input and reducing central sensitisation; this may include neurophysiology education, advice, nerve gliding, strengthening, stretching, home exercise programme, passive mobilisation and other modalities. NSAIDs may help in the short term, but there is a need for drugs that target neuroinflammation. > From: Schmid et al., Man Ther 18 (2013) 449-457. All rights reserved to Elsevier Ltd.
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