II. Definitions: Categories of Peripheral Nerve Injury
- Neuropraxia
- Least severe Peripheral Nerve Injury
- Myelin fibers surrounding the axon are injured focally
- Axon and connective tissue sheath remain unharmed
- Limited duration of injury (typically days to weeks)
- Axonotmesis
- Axon injury, but preserved connective tissue framework
- Risk of distal nerve degeneration
- Recovery over months to years and frequently incomplete nerve regeneration with residual deficit
- Neurotmesis
- Most severe Peripheral Nerve Injury and least common of the three nerve injury types
- Complete axon disruption, as well as disrupted connective tissue framework
- Normal regeneration of the nerve is uncommon and signficant persistent deficit is the norm
III. Pathophysiology
- Mechanisms of nerve injury
- Direct pressure
- Repetitive microtrauma
- Stretch-induced ischemia
- Compression-induced ischemia
- Degree of nerve injury may progress to nerve fibrosis with greater nerve injury
- Severity of injury mechanism
- Duration of exposure to compression or other mechanism
IV. Causes: Upper Extremity
- Images
- Cervical Spine and Cervicobrachial (Axilla)
- Shoulder
-
Humerus
-
Radial Nerve Injury at the Humerus
- Radial Nerve may be compressed in axilla causing Saturday Night Palsy
- Mid-shaft Humerus Fracture may injure Radial Nerve
- Radial Nerve may be entrapped in radial groove
-
Radial Nerve Injury at the Humerus
-
Elbow and Forearm
- Cubital Tunnel (Ulnar Nerve, common)
- Radial Tunnel (and related Posterior Interosseus Nerve Syndrome)
-
Wrist and Hand
- See Overuse Syndromes of the Hand and Wrist
- Carpal Tunnel Syndrome (Median Nerve, very common)
- Ulnar Tunnel Syndrome (Cyclist's Palsy)
- Handcuff Neuropathy (Radial Nerve)
V. Causes: Lower Extremity
VI. Causes: Miscellaneous
- Images
- Face
- Secondary Complications
VII. History
- See Neuropathy
- Musculoskeletal Injury or Trauma to affected region
- Course of symptoms
- Provocative activities
VIII. Exam
-
Musculoskeletal Exam of affected region
- Joint range of motion
- Specific joint exam for region
-
Neurologic Exam
- See Motor Exam
- See Sensory Exam
- See Deep Tendon Reflex
IX. Symptoms
- Burning pain
- Numbness
- Paresthesias
- Motor Weakness
X. Differential Diagnosis
- See Peripheral Neuropathy
- See Mononeuropathy
XI. Imaging
- See Peripheral Neuropathy
- Modalities
- Ultrasound
- Real-time (point-of-care) evaluation of compression sites that reproduce symptoms
- Directed Corticosteroid Injection for certain compression neuropathies
- Magnetic Resonance Imaging (MRI)
- Ultrasound
- Indications
- Severe weakness
- Multiple nerves involved
- Refractory course to 6-8 weeks of specific conservative therapy
XII. Diagnostics: Electrodiagnostic Testing
- See Peripheral Neuropathy
- Modalities (typically performed together)
- Indications
- Localization of nerve lesion in atypical presentations
- Monitoring of nerve injury progression during management
- Presurgical planning
XIII. Management
- See Peripheral Neuropathy
- Initial conservative therapy is preferred for most non-Traumatic compression neuropathies
- Management is specific to the Neuropathy
-
General conservative measures
- Patient Education regarding likely diagnoses and causative factors
- Relative rest with activity modification
- Consider bracing or Splinting (with care not to further compress underlying nerve)
- Consider physical therapy
- Surgical Management
- Indicated in refractory cases
- Lack of full resolution with surgery is common
- Surgical options depend on specific Neuropathy
- Nerve Decompression
- Surgical exploration for underlying cause
- Nerve transfer
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Related Studies
Definition (MSH) | Mechanical compression of nerves or nerve roots from internal or external causes. These may result in a conduction block to nerve impulses (due to MYELIN SHEATH dysfunction) or axonal loss. The nerve and nerve sheath injuries may be caused by ISCHEMIA; INFLAMMATION; or a direct mechanical effect. |
Concepts | Disease or Syndrome (T047) |
MSH | D009408 |
English | Compression Syndrome, Nerve, Compression Syndromes, Nerve, Nerve Compression Syndrome, Nerve Compression Syndromes, Syndrome, Nerve Compression, Syndromes, Nerve Compression, Nerve Compression Syndromes [Disease/Finding], trapped nerve, compression neuropathy, entrapment neuropathy, nerve trap, neuropathy entrapment, entrapment neuropathies, trap nerve, nerve compression syndrome, nerve compression syndromes, nerve entrapment syndrome, compression neuropathies, Nerve compression syndrome |
Swedish | Nervkompressionssyndrom |
Czech | syndromy komprese nervů, neurovaskulární konflikt, tunelové syndromy, úžinové syndromy |
Finnish | Hermopinneoireyhtymät |
Russian | NEVROPATIIA SOPUTSTVUIUSHCHAIA, NERVA SDAVLENIIA SINDROMY, НЕВРОПАТИЯ СОПУТСТВУЮЩАЯ, НЕРВА СДАВЛЕНИЯ СИНДРОМЫ |
Japanese | 圧迫性神経障害, 絞扼神経障害, 絞扼性神経障害, 神経絞扼性障害, 神経圧迫性障害, 圧迫・絞扼性神経障害, 絞扼性末梢神経障害, 神経圧迫症候群, 圧迫絞扼性神経障害, 末梢神経圧迫症候群 |
Croatian | ŽIVCI, KOMPRESIVNI SINDROMI |
Polish | Usidlenie nerwu, Zespoły uciskowe nerwów |
Norwegian | Nerveinnklemmingssyndromer, Nervekompresjonssyndromer |
Portuguese | Compressões de Nervos, Aprisionamentos Neurais, Encarceramentos de Nervos, Aprisionamento de Nervos, Compressões Neurais, Neuropatias Compressivas, Síndromes de Compressão Nervosa |
French | Syndromes de compression nerveuse, Neuropathies de compression |
German | Nervenkompressionssyndrome |
Italian | Sindrome da compressione nervosa |
Dutch | Compressieneuropathie, Neuropathie, compressie-, Compressieneuropathieën, Neuropathieën, compressie- |
Spanish | Síndromes de Compresión Nerviosa |
Ontology: Peripheral Nerve Injuries (C0262593)
Definition (MSH) | Injuries to the PERIPHERAL NERVES. |
Definition (MSHCZE) | Poranění PERIFERNÍCH NERVů. R |
Definition (NCI_CDISC) | Sensory or motor loss of peripheral nerve function due to a traumatic event. |
Definition (NCI) | Sensory or motor loss of peripheral nerve function due to a traumatic event. (ACC) |
Concepts | Injury or Poisoning (T037) |
MSH | D059348 |
SnomedCT | 157657003, 157648009, 287156003, 73590005 |
English | PERIPHERAL NERVE INJURY, Peripheral nerve injury NOS, injury of peripheral nerve (diagnosis), injury of peripheral nerve, Nerve injury, peripheral, Injury;nerve;peripheral, injury nerve peripheral, peripheral nerve injuries, peripheral nerve injury, Nerve Injuries, Peripheral, Nerve Injury, Peripheral, Injury, Peripheral Nerve, Injuries, Peripheral Nerve, Peripheral Nerve Injuries, Peripheral Nerve Injury, Peripheral Nerve Injuries [Disease/Finding], Peripheral nerve injuries, Peripheral nerve injury NOS (disorder), Peripheral nerve injury, PNI - Peripheral nerve injury, Peripheral nerve injury (disorder), injury; nerve, peripheral, nerve; injury, peripheral, Peripheral nerve injury, NOS |
Italian | Traumatismi di nervo periferico, Traumatismo di nervo periferico, Lesioni dei nervi periferici |
Dutch | zenuwletsel, perifeer, letsel; zenuw, perifeer, zenuw; letsel, perifeer, perifere zenuwletsels, perifere zenuwletsel |
French | Lésion nerveuse, périphérique, ATTEINTE D'UN NERF PERIPHERIQUE, Lésions des nerfs périphériques, Lésions nerveuses périphériques, Lésion d'un nerf périphérique |
German | Nervenverletzung, peripher, Periphere Nervenverletzung, Periphere Nervenverletzungen, Verletzung peripherer Nerven, Verletzungen der Peripherienerven |
Japanese | 末梢神経損傷, マッショウシンケイソンショウ |
Portuguese | LESAO DO NERVO PERIFERICO, Traumatismos dos Nervos Periféricos, Lesões dos Nervos Periféricos, Lesão do Nervo Periférico, Traumatismo do Nervo Periférico, Lesão traumática de nervo periférico, Lesões dos nervos periféricos |
Czech | Úrazy periferního nervu, Poranění periferního nervu, poranění periferního nervu, periferní nerv - poranění |
Spanish | lesión traumática de nervio periférico (trastorno), lesión traumática de un nervio periférico, lesión traumática de un nervio periférico (trastorno), Lesión del Nervio Periférico, Traumatismos de los Nervios Periféricos, lesión de nervio periférico, SAI, lesión de nervio periférico, SAI (trastorno), Peripheral nerve injury NOS, injuria de un nervio periférico, lesión traumática de nervio periférico, Lesiones traumáticas de los nervios periféricos, Lesión traumática de nervio periférico |
Hungarian | Perifériás ideg sérülései, Perifériás ideg sérülése, Idegsérülés, perifériás |
Russian | ПЕРИФЕРИЧЕСКИХ НЕРВОВ ПОВРЕЖДЕНИЯ, НЕРВА ПЕРИФЕРИЧЕСКОГО ТРАВМА, NERVA PERIFERICHESKOGO TRAVMA, PERIFERICHESKIKH NERVOV POVREZHDENIIA |
Polish | Uszkodzenie nerwów obwodowych, Urazy nerwów obwodowych |
Norwegian | Skader i det perifere nervesystemet, Skade i det perifere nervesystemet |
Ontology: Axonal neuropathy (C0270921)
Concepts | Disease or Syndrome (T047) |
SnomedCT | 60703000 |
Spanish | Neuropatía axonal, neuropatía axónica (trastorno), neuropatía axónica |
French | Neuropathie axonale |
Dutch | axonale neuropathie |
Portuguese | Neuropatia axónica |
German | axonale Neuropathie |
Italian | Neuropatia assonale |
Japanese | 軸索型ニューロパチー, ジクサクガタニューロパチー |
Czech | Axonální neuropatie |
English | axonal neuropathies, axonal neuropathy, Axonal neuropathy, Axonal neuropathy (disorder), Axonal neuropathy, NOS, Axonal Neuropathy |
Hungarian | Axonalis neuropathia |
Ontology: Neurapraxia (C0393872)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 390012000, 135894004, 316927003, 367319009, 230619007, 370509002, 370607005 |
Dutch | neuropraxie NAO, neuropraxie |
French | Neuropraxie SAI, Neuropraxie |
German | Neuropraxie, Neurapraxie NNB |
Italian | Neuroaprassia NAS, Neuroprassia |
Portuguese | Neuropraxia, Nerurapraxia NE |
English | [Q] Neuropraxia, neuropraxia, neurapraxia, Neurapraxia NOS, [Q] Neuropraxia (qualifier value), Contusion of peripheral nerve, Neuropraxia, Contusion of peripheral nerve (disorder), Neurapraxia (disorder), Neurapraxia (morphologic abnormality), Neurapraxia |
Spanish | Neuropraxia, Neuropraxia NEOM, [Q] neuropraxia, [Q] neuropraxia (calificador), contusión del nervio periférico (trastorno), contusión del nervio periférico, neuroapraxia (trastorno), neuroapraxia, neuropraxia (anomalía morfológica), neuropraxia |
Japanese | ニューラプラキシーNOS, ニューラプラキシー, ニューラプラキシー, ニューラプラキシーNOS |
Czech | Neurapraxie NOS, Neurapraxie, snížení funkce periferního nervu |
Hungarian | Neuropraxia, Neurapraxia k.m.n. |
Ontology: Entrapment Neuropathies (C1510429)
Concepts | Disease or Syndrome (T047) |
MSH | D009408 |
SnomedCT | 155085004, 45781009 |
English | Neuropathies, Entrapment, Neuropathy, Entrapment, Nerve entrapment syndromes, Compression neuropathy (disorder), Entrapment neuropathies, Compression neuropathy, Nerve entrapment syndrome, Trapped nerve, Entrapment neuropathy, Peripheral nerve entrapment syndrome (disorder), Peripheral nerve entrapment syndrome, neuropathy; entrapment, Entrapment syndrome, NOS, Entrapment neuropathy, NOS, Entrapment Neuropathy, Entrapment Neuropathies |
Dutch | inklemmingsneuropathie, neuropathie; inklemming, Entrapment |
French | Syndrome canalaire, Syndromes canalaires, Syndromes tunnelaires |
German | Neuropathie durch Einengung, Engpaß-Neuropathien |
Italian | Neuropatia da intrappolamento, Neuropatie da intrappolamento |
Portuguese | Neuropatia por compressão anatómica, Neuropatias de Encarceramento |
Spanish | Neuropatía compresiva, Neuropatías de Atrapamiento, neuropatía de atrapamiento, síndrome de atrapamiento, síndrome de compresión de nervio periférico, neuropatía por compresión, síndrome de atrapamiento (trastorno), síndrome de atrapamiento de nervio periférico, síndrome de compresión de nervio periférico (trastorno) |
Japanese | コウヤクセイニューロパチー, 絞扼性ニューロパチー |
Czech | Neuropatie tlaková, entrapment neuropatie |
Hungarian | Becsípődéses neuropathia |
Norwegian | Inneklemmingsnevropatier |
Ontology: Neurotmesis of peripheral nerve (C2960651)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 445900004 |
English | Neurotmesis of peripheral nerve, Neurotmesis of peripheral nerve (disorder) |
Spanish | neurotmesis de nervio periférico, neurotmesis de nervio periférico (trastorno) |
Ontology: Axonotmesis of peripheral nerve (C2960652)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 445869000 |
English | Axonotmesis of peripheral nerve (disorder), Axonotmesis of peripheral nerve |
Spanish | axonotmesis de nervio periférico, axonotmesis de nervio periférico (trastorno) |