Nerve Constriction Syndromes - Overview

synonym

Nerve Compression Syndromes

definition

This term encompasses a number of neurological abnormalities in which a peripheral nerve (i.e. not in the central nervous system, but in the body periphery) is narrowed in its course.
Many nerves have to overcome characteristic bottlenecks in their course, so that compression is particularly common here. Often a constriction of a nerve becomes noticeable through neurological symptoms that the person concerned does not initially attach too much importance to, but which sooner or later often lead him to the doctor.

Symptoms

Often at the beginning:

• Abnormal sensations such as tingling or burning,
• Pain in the affected part of the body
• Numbness is not infrequently an indication of such an event
• Motor failures in the sense of paralysis of certain muscles can occur.These can then be visible with a
• Muscle atrophy (diminution).

One of the most common nerve congestion syndromes is carpal tunnel syndrome. Here the median nerve - which, as part of the brachial plexus, is responsible for the nervous supply of the arm - is compressed in the area of ​​the wrist. Other nerves in the area of ​​the upper extremity can also be constricted in various places, such as the radial nerve in the colloquially called "park bench paralysis" on the upper arm or the ulnar nerve in the elbow area ("Funny bones“).

A nerve bottleneck is also possible on the leg. For example, compression of the lateral cutenaus femoris nerve, which is often triggered by wearing trousers or belts that are too tight, or the tibial nerve in tarsal tunnel syndrome, which is caused by constriction of the nerve in the area of ​​the inner ankle.

In the following we provide an overview of the most common nerve congestion syndromes.

Read more on the topic: Meralgia paraesthetica

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Carpal tunnel syndrome

definition

The carpal tunnel syndrome is a nerve congestion syndrome that primarily affects the median nerve (middle arm nerve).
Among the various nerve congestion syndromes, it is considered to be the most common peripheral nerve compression and is now a widespread disease that affects women about three times more often than men.

The carpal tunnel is a tunnel-like, anatomical passage point on the hand, which is formed and delimited from bony and connective tissue parts.
To dorsal (to the back of a part of the body) the carpal tunnel is bounded by a few carpal bones. The bones form a palpable bony elevation on both sides. A band stretches over it, that Retinaculum musculorum flexorum (Transverse carpi ligament), which the carpal tunnel thus after ventral (i.e. above) limited.

The narrowest point has a cross-sectional area of ​​1.6 cm² and lies approximately 1 cm above the center of the posterior row of bones in the carpal roots.

For more information, also check out our main article: Carpal tunnel syndrome

causes

One reason for the symptoms of carpal tunnel syndrome is the compression of the median nerve as it passes through the carpal tunnel in the area of ​​the wrist.

In addition to the most important structure with regard to the carpal tunnel syndrome, the median nerve, ten tendons of the flexor muscles of the hand also run through the carpal tunnel.

If there is a disproportion between the diameter of the carpal tunnel and the volume of the structures it passes through (for example in the case of swelling), the median nerve in particular is affected by complications.

Therefore, the carpal tunnel syndrome is sometimes called Median compression syndrome designated.

The nerve is not only damaged by the mechanical pressure but also by a lack of blood supply. In the EMG (Electromyography) show Denervation mark and a reduced nerve conduction velocity.

A tightness in the carpal tunnel can be caused and favored by various factors. Structural deviations in the limiting structures or a hereditary predisposition for a narrow carpal tunnel can give rise to a carpal tunnel syndrome.

Degenerative changes such as in rheumatoid arthritis or endocrine-metabolic disorders such as existing diabetes mellitus or pregnancy also lead to the corresponding symptoms of carpal tunnel syndrome.
With the latter disorders, there is an increase in connective tissue, resulting in a narrowing of the carpal tunnel.

A common cause that also leads to narrowing is tendinitis, which is accompanied by swelling and thus corresponds to a space-consuming process. Injuries in the form of Dislocations (Ball dislocation) and fractures of the carpal bones can also trigger a carpal tunnel syndrome.

Ultimately, the component of mechanical stress should not be forgotten, since carpal tunnel syndrome can be provoked by everyday movement patterns. This includes the bending hand movement, especially in combination with the application of force.

There is also an increased risk for dialysis patients and overweight people.
In addition, clinical pictures such as polyneuropathy, hypothyroidism, acromegaly, gout and amyloidosis are considered to be favorable factors.

Symptoms

Symptoms can vary depending on the severity and cause of the carpal tunnel syndrome.

Frequently, patients complain of nighttime pain, as well Paresthesia, i.e. abnormal sensations such as tingling and numbness in the thumb, index and middle fingers, as these areas correspond to the supply area of ​​the median nerve, which runs through the carpal tunnel.
In severe cases, the pain can even radiate into the shoulder.

Pain can be made worse by applying pressure or stretching the wrist.

Paresthesia can be determined with the clinical test "Hoffmann-Tinel sign“Control by tapping the front of the hand. The test is mainly used in the diagnosis of carpal tunnel syndrome in order to be able to observe possible nerve regeneration during the course.

For more information, also check out our main article: Carpal tunnel syndrome diagnosis

In addition, the fine motor skills can be disturbed, as from a certain level it can also lead to degeneration of the muscles.
This is typical of carpal tunnel syndrome Thenar atrophy (lat. Thenar: Thumb; atrophy: Tissue atrophy of the muscles), in which the thumb ball muscles are less pronounced than before the disease.

The two muscles Mm. opponens pollicis and Mm. abductor pollicis brevis. In this case there will be a Opposition weakness; a movement in which the thumb is moved towards the little finger.

This movement is essential for access, but if the median nerve is compressed, the opposition movement is only possible to a limited extent.

The classic first manifestation of the symptoms mentioned is pain at night and abnormal sensations.
Only later can the pain appear throughout the day. In addition, the likelihood of muscle wasting increases in the further stages of the disease.

therapy

Carpal tunnel syndrome is usually treated with surgery. This sees a severing of the Flexor retinaculum which limits the carpal tunnel to the front (ventral).

Thus, in that channel for the through-going structures, especially the median nerve, created more space so that the compression symptoms of carpal tunnel syndrome can be alleviated.
In addition to the surgical therapy, conservative treatment in the sense of protection by a night splint can also be used.

The choice of therapy for carpal tunnel syndrome depends on the severity of the carpal tunnel syndrome. Carpal tunnel syndrome that occurs during pregnancy (lalso eat: Carpal tunnel syndrome during pregnancy) can heal on its own.

For more information, also check out our main article: Carpal tunnel surgery

Tarsal tunnel syndrome

definition

This nerve constriction syndrome can be divided into anterior and posterior tarsal tunnel syndrome.
The classification is based on the affected nerves: the anterior one is compressed N. fibularis profundus and at the rear to compression of the Tibial nerve. Both are nerve branches of the sciatic nerve (Sciatic nerve).

root cause

Women who often wear high shoes, in particular, have an increased risk of anterior tarsal tunnel syndrome.
Incorrect foot posture can also promote the development of a tarsal tunnel syndrome (such as a flat arched foot).

In general, space-occupying processes are considered to be the cause of the symptoms that can arise due to an inflammatory disease (e.g. rheumatism), a fracture or an ankle sprain.

Symptoms

The symptoms depend in part on whether it is an anterior or posterior tarsal tunnel syndrome. In general, the pain on the inner edge of the foot and the sole of the foot is characteristic.

During the day, the pain can worsen due to the mechanical stress on the legs and feet. This is accompanied by impaired sensitivity in the form of tingling and numbness in the corresponding areas.

If the compression lasts longer or if it is too strong it can even lead to one Paresis, that is, paralysis of the short muscles of the foot.

therapy

As always, two treatment options are available: either conservative or surgical treatment.

As a rule, one tries first to achieve an improvement in the symptoms through conservative therapy. Among other things, insoles are used that lift the inner edge of the foot slightly and can alleviate the compression pressure in the case of incorrect foot posture.

Drug therapy with anti-inflammatory and analgesic agents is also standard in the conservative treatment of tarsal tunnel syndrome.

Operationally, by splitting the Retinaculum musculi flexorum pedis, a band-like structure between the inner calcaneus and the inner malleolus provide relief.

For more information, also check out our main article: Tarsal tunnel syndrome

Loge de Guyon syndrome

definition

The Loge de Guyon syndrome is a nerve bottleneck syndrome that affects the distal portion of the Ulnar nerve (Elbow nerve), hence the synonym "Syndrome of the distal ulnar compartment". The ulnar nerve can also be found further up in the area of ​​the elbow, in the Ulnar sulcusto be harmed.

The Guyon Lodge is a anatomical bottleneck in the area of ​​the wrist through the ulnar nerve and the Ulnar artery (Elbow artery) runs.
Like the carpal tunnel, the Guyon Lodge is passed through bony and connective tissue Structures limited. This includes that Pea bone (Os pisiform), the hook process of the Hook bone (Hamulus ossis hamati) and the Flexor retinaculum.
The flexor retinaculum is limited at the same time the Lodge de Guyon after dorsal (below) and the Carpal tunnel to ventral (above).

root cause

Loge de Guyon syndrome can develop after one Wrist fracture or by a maximum extension in the wrist come, whereby the elbow nerve is then compressed in its course by the Guyon lodge.

It can also be done in the Loge de Guyon ganglion (Überbein) come to space-consuming processes.
The ganglion is one tumor-like tissue change, which is very typical for this job and which is Joint capsules or Tendon sheaths trains.

For more information, also check out our main article: ganglion

Also ask mechanical overstress such as long cycling or regular handicrafts with the little finger ball is a risk factor for Loge de Guyon syndrome.

Symptoms

Of the Ulnar nerve divides during the course through the Guyon Lodge into 2 branches on: in one superficial (Ramus superficialis) and a deep Branch (Ramus profundus).

The Ramus profundus, which for the motor innervation the muscles are responsible is a lot more likely to suffer from entrapment than the superficial branch which the sensitive parts includes.

Therefore they are more likely to stand motor failure symptoms in the foreground. These are expressed in the Impairment of thumb adduction, So that the Fine motor skills and the Write Cause problems.
In addition, it comes to Paresthesia (Discomfort) with Tingling and numbness in the supply area of ​​the ulnar nerve; so in the little finger and Parts of the ring finger.

The symptoms of Loge de Guyon syndrome will vary according to their severity according to the Gross and Gelbermann classification.

therapy

The Loge de Guyon Syndrome is in its early stages a largely reversible nerve compression syndrome. Before the indication of a surgery is asked is a conservative therapy often sufficient.

The choice of therapy also depends on the root cause from.

A Loge de Guyon syndrome caused by a mechanical overload can be treated with a conservative method first.
This is done in the sense of discharge and Avoiding heavy and regular exposure, because the nerve can regenerate relatively quickly.

For more information, also check out our main article: Loge de Guyon syndrome

diagnosis

Relevant for the diagnosis of a Nerve congestion syndrome is first of all that anamnese (what does the patient report?) and the clinical examination.

As Additional examinations especially those from the field of Electrophysiology, for example a Measurement of the nerve conduction velocity, on.
This determines whether an externally applied electrical stimulus is being conducted at “normal” speed to a remote location, or whether there is a line delay here.

therapy

If the symptoms are rather mild, you can usually try one conservative therapy on. Here come for example

• Painkiller,
• Immobilization by means of a splint and
• physical therapy for use.

If the symptoms persist or there are significant neurological deficits, a operative therapy Be the means of choice. Here the goal is one decompression of the nerve. This can be done, for example, by splitting constricting structures or even relocating the affected nerve into a less narrow area, but is specific to the respective clinical picture.