Nerve Entrapment Syndromes (NES)
Nerve Entrapment Syndromes (NES)
Nerve Entrapment Syndromes (NES), also known as nerve compression syndromes or entrapment neuropathies, occur when a peripheral nerve is chronically compressed or trapped by surrounding tissues such as ligaments, muscles, or bones. This compression impairs the nerve’s ability to transmit signals, leading to a range of sensory and motor symptoms localized to the nerve’s distribution area.
Causes
- Chronic pressure from anatomical structures (ligaments, bones, muscles)
- Swelling or inflammation of surrounding tissues
- Repetitive motions or overuse injuries (common in occupational or sports activities)
- Trauma or injury (fractures, sprains)
- Anatomical abnormalities or variations
- Pregnancy-related swelling
- Systemic conditions (e.g., diabetes, thyroid disease)
- Scar tissue or adhesions tethering the nerve
Commonly Entrapped Nerves
- Median nerve: Carpal tunnel syndrome (wrist)
- Ulnar nerve: Cubital tunnel syndrome (elbow)
- Radial nerve: Radial tunnel syndrome (forearm)
- Sciatic nerve: Sciatic nerve entrapment (buttock/thigh)
- Peroneal nerve: Fibular tunnel syndrome (knee)
- Tarsal tunnel syndrome: Posterior tibial nerve at the ankle
- Pudendal nerve: Pelvic entrapment causing pelvic pain or dysfunction
Symptoms
- Sensory: Pain (sharp, burning, shooting), tingling, numbness, paresthesias localized to nerve distribution
- Motor: Muscle weakness, impaired movement, muscle wasting (in chronic cases)
- Autonomic (in some pelvic nerve entrapments): Incontinence, sexual dysfunction
- Symptoms may be continuous, intermittent, or positional (e.g., pain worsens with certain postures)
- Early symptoms often include positive sensory phenomena (tingling, neuropathic pain), followed by sensory loss and muscle weakness if untreated
Diagnosis
- Clinical examination: Assess sensory changes, muscle strength, reflexes, and provocative tests
- Electrophysiology: Nerve conduction studies and electromyography (EMG) to evaluate nerve function and localize compression
- Imaging: Ultrasound, MRI, or CT to visualize nerve entrapment and exclude other causes
- Diagnostic nerve blocks: Temporary anesthesia to confirm the nerve involved
Treatment
- Conservative: Rest, activity modification, physical therapy, splinting or bracing, anti-inflammatory medications
- Manual therapies: Manual lymphatic drainage, nerve gliding exercises
- Injections: Corticosteroid or anesthetic injections to reduce inflammation and pain
- Surgery: Nerve decompression or release if conservative measures fail or if there is progressive weakness or muscle atrophy
Prognosis
- Early diagnosis and treatment improve outcomes and may prevent permanent nerve damage
- Chronic untreated entrapment can lead to irreversible nerve injury and functional impairment
Summary Table
| Aspect | Details |
|---|---|
| Definition | Chronic compression or trapping of a peripheral nerve causing sensory and/or motor symptoms |
| Common Causes | Anatomical compression, repetitive use, trauma, inflammation, adhesions |
| Typical Symptoms | Pain, tingling, numbness, muscle weakness, sometimes autonomic dysfunction |
| Common Sites | Wrist (median nerve), elbow (ulnar nerve), forearm (radial nerve), leg (sciatic, peroneal) |
| Diagnosis | Clinical exam, nerve conduction studies, imaging, diagnostic nerve blocks |
| Treatment | Conservative (rest, PT, meds), injections, surgery if needed |
| Prognosis | Good if treated early; risk of permanent damage if delayed |
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References:
1 Wikipedia – Nerve compression syndrome
2 Cleveland Clinic – Nerve Compression Syndromes
3 Physiopedia – Nerve Entrapment
4 RWJBarnabas Health – Entrapment Neuropathy
5 Neurosurgery CNJ – Nerve Entrapment
6 Apex Soft Tissue & Spine – Nerve Entrapment
7 Medscape – Nerve Entrapment Syndromes
8 Healthline – Nerve Compression Syndrome
