Nerve Conditions

Nerve Conditions

Carpal Tunnel Syndrome

Overview: Carpal tunnel syndrome involves the median nerve. As this nerve enters the wrist, it must pass through the carpal tunnel before continuing into the hand.

Causes: CTS is multifactorial and is usually secondary in nature. The carpal tunnel is an enclosed space with numerous tendons, a vein, an artery and the median nerve. With repetitive or forceful movements of the hand and wrist, the tendons that pass through the carpal tunnel become inflamed and swollen, which decreases the space inside the tunnel and compresses the median nerve. Some people are born with a smaller carpal tunnel and are therefore predisposed to CTS.

Symptoms: Symptoms are typically gradual and progressive. Numbness and tingling of the palmar side of the hand, including the thumb, index finger, middle finger and ring finger, is felt. CTS may progress to hand weakness and atrophy of the thumb muscles. Nighttime symptoms are common due to wrist flexion that occurs during sleep.

Treatment: Oral or topical anti-inflammatory agents can provide relief. Wearing night splints to prevent wrist flexion during sleep can also be helpful. Occupational therapy can teach stretching techniques, followed by strengthening of the arms. Education on how to perform certain activities more efficiently can also be very helpful. An ultrasound-guided injection of either PRF or steroid around the median nerve can provide relief. Surgical release of the carpal tunnel is reserved for those who either do not respond to conservative care or present with more severe CTS.

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Cubital Tunnel Syndrome

Overview: Cubital tunnel syndrome involves the ulnar nerve. As this nerve travels down the arm, it must pass through the cubital tunnel that is located along the inner part of the elbow.

Causes: Cubital tunnel syndrome is secondary to irritation of the ulnar nerve. This can be due to leaning on the elbow, sustained elbow flexion or excessive physical activity, such as pitching.

Symptoms: Symptoms are typically gradual and progressive. Numbness and tingling of the ring and pinkie fingers is common. Cubital tunnel syndrome may progress to hand weakness and atrophy of the muscles within the hand.

Treatment: Oral or topical anti-inflammatory agents can provide relief. Elbow splints to prevent elbow flexion during sleep can also be helpful. Physical therapy can teach stretching techniques, followed by strengthening of the arms. Education on how to perform certain activities more efficiently can also be very helpful. An ultrasound-guided injection of either PRF or steroid around the ulnar nerve can provide relief. Surgical release of the cubital tunnel is reserved for those who either do not respond to conservative care or present with more severe cubital tunnel syndrome.

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Radial Tunnel Syndrome

Overview: Radial tunnel syndrome involves the radial nerve. As this nerve travels down the arm, it must pass between the bones and muscles of the elbow and forearm.

Causes: Radial tunnel syndrome is secondary to irritation of the radial nerve. This can be due to direct nerve injury through trauma, tumor or inflammation of tissue that surrounds the nerve.

Symptoms: Sharp pain over the back of the forearm or hand is notable. This is worsened with trying to extend the wrist and fingers. There is rarely numbness or tingling, and muscle weakness is common.

Treatment: Oral or topical anti-inflammatory agents can provide relief. Elbow or wrist splints can immobilize the arm and allow the nerve to rest. Physical therapy can teach stretching techniques, followed by strengthening of the arms. Education on how to perform certain activities more efficiently can also be very helpful. An ultrasound-guided injection of either PRF or steroid around the radial nerve can provide relief. Surgical removal of the irritating factor is helpful in cases of tumor.

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Tarsal Tunnel Syndrome

Overview: The tarsal tunnel is formed between the medial malleolus (inner ankle bone) and the flexor retinaculum (a local band of ligaments). Within the tarsal tunnel are nerves, arteries and tendons.

Causes: Tarsal tunnel syndrome is secondary to irritation of the tibial nerve. This can be due to altered biomechanics of the foot, local swelling due to trauma, systemic disease or direct trauma.

Symptoms: Symptoms include numbness and tingling in the foot, or shooting pain in the foot.

Treatment: Oral or topical anti-inflammatory agents can provide relief. Ankle braces can be used to prevent ankle positions that increase pressure on the tibial nerve. An ultrasound-guided injection of either PRF or steroid around the tibial nerve can provide relief. Surgical release of the tarsal tunnel is reserved for those who either do not respond to conservative care or present with more severe symptoms.

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Occipital Neuralgia

Overview: Occipital neuralgia is a condition in which the greater and lesser occipital nerves become irritated or injured. These nerves arise from the base of the skull and travel over the back and upper part of the head.

Causes: The occipital nerves become irritated with compression or entrapment. This can be due to trauma, tight neck muscles, tumors and arthritis.

Symptoms: Irritation of the occipital nerves presents with headache-type pain that begins in the base of the skull and travels over the back and upper part of the head. Eye pain, scalp tenderness, neck pain and sensitivity to light are all common.

Treatment: Anti-inflammatory medications can provide relief. If the nerves are directly compressed, decompression techniques would be necessary. This might include applying heat and massage to tight neck muscles, or having masses or tumors removed. Occipital nerve blocks are a simple office procedure that can provide drastic relief for prolonged periods of time.

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Peripheral Neuropathy

Overview: Peripheral neuropathy is a condition in which one or more nerves outside of the central nervous system are damaged.

Causes: Nerve damage can be due to direct trauma to the nerve(s), exposure to toxins, infections or systemic disease. Genetics also plays a role in the development of neuropathy.

Symptoms: Typically, symptoms begin in the feet and travel up through the leg, followed by symptoms in the hands that travel up through the arms. In more severe cases, the chest and face may also be affected.

Treatment:If the neuropathy is caused by a systemic condition, treatment of that condition may improve the neuropathy symptoms. Medications that specifically decrease nerve pain are available. Physical therapy can assist in desensitization techniques and strengthening to keep an individual functional for as long as possible. Ultrasound-guided nerve blocks can provide relief.

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Thoracic Outlet Syndrome (TOS)

Overview: Thoracic outlet syndrome describes a disorder that occurs when nerves and/or vessels are compressed in the front portion of the neck or the axilla (armpit). The thoracic outlet is the space between the lower neck and axilla where this group of nerves and vessels are found.

Causes: The small thoracic outlet region can become compressed, which can lead to direct compression on the nerves and/or vessels passing through this region. Compression can be due to tight muscles, altered biomechanics of the spine/shoulder complex, extra cervical rib, tumor or swelling of surrounding tissue. Athletes who throw, weightlifters and those with shoulder injuries are commonly found to have symptoms of TOS.

Symptoms: Neck, shoulder and arm pain are common complaints. Numbness and tingling involving the inner portion of the arm and hand are also very common. The condition can progress to the point where weakness and muscle atrophy occurs.

Treatment: Medications including anti-inflammatory and anti-neuropathic pain agents are helpful. Physical therapy can help to improve the length of tight muscle in the region and improve postural changes. When the compression is due to an extra cervical rib or tumor, surgical removal of these entities is helpful. Some data suggest that stem cells placed around the thoracic outlet region can be very helpful in treating the nerve damage in the region.

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Meralgia Paresthetica (Lateral Femoral Cutaneous Neuropathy [LFCN])

Overview: Meralgia paresthetica occurs when the lateral femoral cutaneous nerve of the leg is irritated. This nerve is a large sensory nerve that only provides sensation to the front and outside portion of the thigh.

Causes: Nerve irritation is the cause of meralgia paresthetica. The LFCN runs over the ilium (hip bone), where it becomes very superficial. Compression, entrapment or trauma at this site can damage the nerve. Tight clothing or belts, obesity, rapid weight gain/loss and pregnancy are also common causes.

Symptoms: Numbness, tingling and pain to the anterior and outer thigh on the affected side are common. As the affected nerve is only a sensory nerve, no weakness or muscle atrophy is expected.

Treatment: Discontinuing the offending factor, such as wearing looser clothing, may resolve the symptoms. In other cases where nerve compression is due to a tumor, surgical removal of the tumor is necessary. Oral or topical anti-inflammatory medications can be helpful. Ultrasound-guided injection around the LFCN at the site of damage can also provide relief. In rare cases, surgical decompression of the nerve may be necessary.

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