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10 Feb2014

10 February 2014.

Written by Romain Haym
Posted in Neurological

Written by Romain Haym10-02-2014 08:30:00. Posted in Nervous

Neuroinflammation is a potential contributor to extraterritorial spread in entrapment neuropathies (Image by: mdsystems.com)

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.

Visit the PubMed summary or watch an amazing TEDtalk on chronic pain by Elliot Krane below:

 

Symptoms in entrapment neuropathies are causes by changes in the entire nervous system
(Image by: 3D4medical (edited))

Tags: diagnosis, pathology, management, Nervous system, Peripheral nervous system, entrapment neuropathy

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Romain Haym

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  • Articles
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