Chapter 19 - Compression and entrapment neuropathies

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Abstract

Peripheral nerve entrapments are frequent. They usually appear in anatomical tunnels such as the carpal tunnel. Nerve compressions may be due to external pressure such as the fibular nerve at the fibular head. Malignant or benign tumors may also damage the nerve. For each nerve from the upper and lower limbs, detailed clinical, electrophysiological, imaging, and therapeutic aspects are described. In the upper limbs, carpal tunnel syndrome and ulnar neuropathy at the elbow are the most frequent manifestations; the radial nerve is less frequently involved. Other nerves may occasionally be damaged and these are described also. In the lower limbs, the fibular nerve is most frequently involved, usually at the fibular head by external compression. Other nerves may also be involved and are therefore described. The clinical and electrophysiological examination are very important for the diagnosis, but imaging is also of great use. Treatments available for each nerve disease are discussed.

Introduction

Peripheral nerves may be entrapped in an anatomical tunnel (carpal tunnel, ulnar tunnel) or compressed either by external pressure (fibular nerve at the fibular head) or by abnormal anatomical structures. Ganglionic cysts or tumors may also damage peripheral nerves. Clinical history and examination are usually useful for an exact diagnosis. Electrophysiological study is the gold standard to confirm the peripheral nerve lesion, to localize the site of entrapment or compression, and to evaluate the degree of nerve damage. Imaging techniques are growing in interest to diagnose peripheral nerve lesions. For each nerve, anatomy, causative disorders, clinical features, electrophysiological and imaging studies, and treatment will be discussed.

Section snippets

Anatomy

The median nerve is formed by fibers from the medial (C8 and T1 roots) and lateral cords (C5, C6, and C7 roots) of the brachial plexus. Above the elbow, a ligament of Struthers may be present. The median nerve and often the brachial artery course beneath it. In the upper forearm, the nerve passes between the two heads of the pronator teres muscle (Fig. 19.1). The nerve courses deep to the flexor digitorum sublimis, passing under the tendinous arch of that muscle (the sublimis bridge). The nerve

Anatomy

The lateral cutaneous nerve of the thigh arises from the lumbar plexus and the L2 and L3 spinal nerves. It emerges from the lateral border of the psoas major and runs down and laterally in the pelvis, lying on the iliacus muscle (Fig. 19.18). It reaches the lateral end of the inguinal ligament, passing either under or through, sometimes through a small tunnel formed by a split in its lateral attachment to the anterior superior iliac spine.

Disorders

Lateral femoral cutaneous nerve (LFCN) entrapment is

Acknowledgment

I thank Dr Dan Levine for his help in writing the chapter.

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