nerve entrapment syndrome
Introduction
Introduction to nerve compression syndrome The nerve compression syndrome is a bone-fiber tube, one of the chamber compression syndromes. For the peripheral nerves, a certain part of the bone fiber tube, a small number of fibrous edges caused by compression and chronic damage caused by inflammatory reactions, resulting in abnormal neurological function. The lesions are located in some specific anatomical parts, bone-fiber tube, or inelastic muscle fiber edge, zygomatic arch and other critical points of the nerve channel, where the compressed nerve is difficult to avoid and buffer. basic knowledge The proportion of illness: 0.06%-0.09% Susceptible people: no specific population Mode of infection: non-infectious Complications: edema
Cause
Causes of nerve compression syndrome
The lesions are located in some specific anatomical parts, bone-fiber tube, or inelastic muscle fiber edge, sacral arch and other nerve channel key compression points, where the compressed nerve is difficult to avoid, buffer, the cause can be summarized into three categories :
1 intra-tube compression: ganglion cyst, neurofibromatosis, chronic chronic inflammation of the nerve.
2 external compression: osteophytes, bone and key injuries, ligament injury.
3 systemic diseases: rheumatoid arthritis, mucous edema, obesity, diabetes, hyperthyroidism, Reynaud disease, pregnancy, etc. can be combined with nerve compression.
Prevention
Nerve compression syndrome prevention
Nerve compression syndrome is a kind of disease that is closely related to modern living and working conditions. It can be prevented completely, and the prevention method is very simple. It is to avoid the long-term stalemate of the upper limbs and the working state of mechanical and frequent activities. For a while, you will be active in your limbs and do some relaxing exercises.
Complication
Complications of nerve compression syndrome Complications edema
The main complication of this disease is that when the compression is severe and long-lasting, it can cause demyelination of nerve fibers, even the distal axonal disintegration, Waller degeneration of myelin, and limb movement, nerve fibers in the narrow channel. Chronic injury-induced inflammation occurs under stimulation, and the vicious circle of edema-ischemia is aggravated, which further causes damage. Therefore, patients with this disease should be actively treated to prevent complications.
Symptom
Symptoms of nerve compression syndrome Common symptoms Sensory disorder Rheumatoid arthritis Joint pain Muscular atrophy Nutrition disorder Paralysis cyst Shoulder pain
1. Pain and paresthesia: A sensory loss or abnormality may occur according to the innervation of the dermis.
2, nighttime aggravation is also called rest pain.
3, the pain can be radiated to the proximal side of the proximal side, and need to be identified with double compression.
4, muscle atrophy, weakness, movement is not coordinated.
5, sympathetic involvement: manifested as temperature, color, sweating and nutritional disorders.
6, the limitations of the compression point tenderness, radiation, compression points on the far and near sides have tenderness called Vallex phenomenon.
7, Tinel sign: for the card pressure point of the light pain and numbness.
Nerve compression syndrome
(A) carpal tunnel syndrome This disease, also known as delayed median nerve paralysis, is the median nerve caused by compression in the carpal tunnel, the carpal tunnel is located in the base of the palm, the bottom and sides are composed of the carpal bone, the transverse gland of the gland spans A bone-fiber channel is formed.
Long-term overuse of the hands and wrists causes chronic damage, and the transverse ligaments and tendons of the wrist can cause chronic injury inflammation, which makes the stenosis the most common cause, followed by acute wrist injury, distal radius fracture, and lumbar dislocation. Causes acute or secondary compression of the median nerve. Some systemic diseases can be enlarged by the contents of the carpal tunnel, causing spontaneous median nerve damage.
The age of good hair is 30 to 60 years old, and the female is 5 times of male. It is usually unilateral, or bilateral, with slow onset, pain in the median nerve innervation, numbness, bloating, and often wakes up after a few hours of sleep. After the activity, the skin in the median nerve distribution area is dull, allergic, the big fish may have atrophy, the thumb is awkward and weak, the Tinel sign may appear on the wrist, the wrist may be flexed for 60 seconds, and the feeling of the hand may be aggravated (Phalen test) ), the internal pressure of the carpal tunnel is increased, the sphygmomanometer is inflated for more than 30 to 60 seconds after systolic pressure, which can induce pain in the hand. Excessive wrist and flexion test also cause paresthesia and aggravation of pain. The wrist of the carpal tunnel is tender and painful, and the median nerve The conduction speed is slowed down.
Non-surgical treatment makes the wrist brake in the neutral position, carotid hormone injection in the carpal tunnel, repeated attacks, non-surgical treatment is difficult to relieve the need for surgical decompression, there are reports of the use of endoscopic surgery.
(B) wrist and cannula syndrome
This disease is also known as Guyon tube syndrome, bean-hook hole syndrome, Ramsay-Hunt syndrome, the wrist of the ruler tube is triangular, the front wall is the transverse wrist transverse ligament, the posterior wall is the deep wrist transverse ligament, and the inner wall is the wrist. The bean bone and the bean hook ligament, the ulnar nerve and the ruler move, the vein passes, and the ulnar nerve is compressed in it to cause the ruler syndrome.
The most cases were caused by ganglion cysts, accounting for 28.7%, chronic injuries accounting for 23.5%, and contusions accounting for 10.3%. Other causes were fractures, congenital malformations and generalized pain.
The shallow branch is involved in the sensory disturbance of the ulnar nerve innervation area. The deep branch compression can cause the internal muscle atrophy of the hand, weakness, deep pain and burning in the hands, significant pain at night, adduction of the thumb, and weakness of the other four fingers. The little finger can be expressed as a claw-shaped deformity, the paper test, the Froment test is positive, and the electrophysiological examination can find the EMG of the muscle fiber fibrillation, and the nerve conduction velocity is slowed down.
If the non-surgical treatment is ineffective, the Guyon tube can be surgically opened, and the ulnar nerve is fully decompressed and released.
(three) pronatorial round muscle syndrome
The middle nerve is in the proximal end of the forearm, and is caused by the compression of the zygomatic arch between the two ends of the pronator. When the forearm is in the pronation, the median nerve is lifted by the anterior circumflex of the pronator, so the disease is more common in the forearm. Two kinds of pronation, pain in front of the elbow, can be radiated to the lateral three fingers, may have weakness, excessive use of the arm will aggravate the pain, the median nerve innervation area may have numbness, burning sensation and objective sensory disturbance, pronation The upper edge of the round muscle may have tenderness, Tinel sign, and weakness to the palm. Local corticosteroid injection can relieve the symptoms. When it is invalid, it can be surgically cut off the card or the fiber band.
(4) anterior interosseous nerve compression syndrome
This disease, also known as Kiloh-Nevin syndrome, is caused by the anterior interosseous nerve branch of the median nerve referred to as the upper arch of the superficial flexor of the superficial flexor or the fibrous band, which is characterized by pain in the elbow and the distal finger of the thumb and the two fingers. The flexion of the inter-articular joint is weakened. For example, the full flexion of the flexor hallucis longus can be expressed as a sign. When the elbow is flexed, the muscles with weak frontal muscles can be found, the hand feels normal, and the internal tendon without hands.
(5) fistula syndrome
This disease is also known as zygomatic arch syndrome, supinator syndrome, and dorsal nerve card tenderness. It is the deep branch of the phrenic nerve in the sacral canal. Caused, slow onset, can gradually occur to extend the metacarpophalangeal joint, stretch the thumb, abduction thumb weakness, stretch the wrist biased to the temporal side, because the ulnar extension of the wrist muscles involved, the radial extensor muscles intact, no paresthesia, no Pain, the middle finger test is positive in this disease. When the examination is performed, the elbow, wrist and interphalangeal joints are straightened. The resistance to the extension of the metacarpophalangeal joint induces the pain in the medial edge of the short extensor muscle of the temporal side of the wrist. The tennis elbow pain appears in the upper and lower jaws. Surgery requires exploration of the common compression points of the dorsal nerves in the bone, including the front of the humeral head, the short-extension muscle arch of the temporal wrist and the Frohse arch of the supinator.
(6) Elbow cannula syndrome
This is caused by the compression of the ulnar nerve in the bone fiber channel composed of the elbow tube. The inner side is the inner upper iliac crest, the outer side is the olecranon, the bottom of the tube is the ulnar nerve groove, and the inner upper iliac crest is connected with the olecranon. Coverage, common diseases due to excessive elbow activity, sequelae of elbow trauma, congenital malformation, and elbow joint pain, such as osteoarthrosis, tuberculosis, rheumatoid arthritis can cause ulnar nerve compression, slow onset, forearm ulnar side, hand ruler Side, fourth, five fingers numbness tingling, ring small finger flexion weakness, ulnar nerve innervation area sensory disorder, may have internal muscle atrophy, claw-shaped hand (ring small finger) deformity, paper test, Froment test positive, ulnar nerve groove can be touched To the thickening of the nerves, tenderness, Tinel sign positive, electrophysiological examination is helpful for diagnosis, non-surgical treatment is ineffective when ulnar nerve advancement and humeral internal iliac crest resection.
(7) Scapular nerve compression syndrome
This is caused by the compression of the suprascapular nerve in the scapula in the upper corner of the scapula. The outside of the incision is the base of the condyle. The transverse ligament on the lateral cross-section of the inlet forms a bone-fiber tube, and the shoulder is overactive for a long time. Occupational disease is easy to cause this disease, which is characterized by persistent blunt shoulder pain, radiation to the neck and scapular region, increased shoulder pain, increased elbow pain, weak shoulder abduction, and atrophy of the upper shoulder muscle and the infraspinatus muscle. However, there is no local tenderness.
(8) Piriformis syndrome
The sciatic nerve passes over the ischial notch, usually in front of the piriformis, and penetrates through the piriformis in the lower edge of the muscle and the superior iliac muscle. The compression causes piriformis syndrome, and the cause is mainly pear-shaped. Acute or chronic injury of the muscles, complaining of hip pain and paresthesia, and radiating to the posterior side of the femur. Examination can reveal deep tenderness in the piriformis. Anti-resistance of hip abduction and external rotation can induce pain and feel activity weakness. Hip, adduction, internal elbow pain increased.
(9) Lateral cutaneous nerve compression syndrome
The lateral femoral cutaneous nerve passes through the anterior superior iliac spine, and the bone-fiber tube formed between the anterior superior iliac spine and the outer layer of the inguinal ligament is subjected to compression, which is caused by burning pain and numbness in the lateral femoral cutaneous nerve innervation area. , allergies, touch, pain, temperature perception may be weakened, the anterior superior anterior superior iliac spine may have tenderness, radiation pain, hip over-extension may increase the pain, no movement disorders.
(10) sacral nerve compression syndrome
The common peroneal nerve is compressed in the bone-fascial tube of the humerus neck, and the injury and extracorporeal compression are common causes, which are manifested as pain in the foot and lateral calf, numbness, dyskinesia, extension of the toe, and valgus. Weakness or disappearance, there may be sensory disturbances on the lateral side of the calf and the lateral side of the foot. There may be tenderness and Tinel sign at the humeral neck.
The compression of the superficial percutaneous nerve branch at the exit of the deep fascia at the distal end of the calf is another intrinsic compression point. Injury and over-tightening of the footwear can lead to the disease, which only manifests as pain and paresthesia in the innervation area.
(11) fistula syndrome
The posterior tibial nerve is compressed in the bone-fiber tube formed by the flexor support band and the calcaneus in the posterior tibial nerve. The chronic injury caused by excessive use of the foot is a common cause, and the complaint is intermittent prickly pain in the sole or heel. Burning or numbness, standing or walking for a long time can aggravate the pain, often have nighttime pain, make the patient wake up, there may be tenderness and Tinel sign in the medial malleolus, the flexion of the metatarsophalangeal joint is weak, and the tourniquet inflation test can induce foot pain.
(12) Total fundus nerve compression syndrome
This disease, also known as Morton's disease, Morton's painful sign may be caused by the compression of the toe-bottom nerve between two adjacent humeral heads, the intercondylar deep ligament and the diaphragm. The cause is often standing for a long time and accumulating. Chronic injury, complaining of paroxysmal burning under the humeral head, involving the third, four toes, walking and standing can aggravate the pain, relieve and rest after taking off the shoes, lateral compression of the humeral head can cause pain in the interval, non Surgical treatment allows patients to wear loose flat soft shoes, support the plastic flat crossbow, traditional surgical removal of painful neuroma, in recent years reported to cut the deep interphalangeal ligament to obtain excellent results.
Examine
Examination of nerve compression syndrome
The disease has many sites, and the inspection methods of each site are different. It is impossible to enumerate them. From various general examinations, the ERG examination of radiculopathy can show fiber tremor and denervation potential, generally no conduction. Slower speed, peripheral nerve involvement may have slower conduction velocity and slower distal latency, while X-ray plain film can only find signs of bone hyperplasia and old injury, and some diagnostic nerve block methods can be used. It is applied to patients with atypical clinical manifestations. The main nerve injection 1% lidocaine 2ml can be selected at the site suspected of developing neurological compression syndrome. If the patient's clinical symptoms are relieved quickly, it is helpful for diagnosis.
Diagnosis
Diagnosis and differentiation of nerve compression syndrome
Because of the many parts of the nerve compression syndrome, the diagnosis of the nerve compression syndrome in each part needs to be differentiated from the similar diseases that may occur here. Therefore, it is impossible to describe here one by one. The compression syndrome is an example of some cases where differential diagnosis is required:
Due to the local anatomical features of the median nerve of the forearm, there are multiple compressions of the median nerve of the forearm. It should be differentiated from the diseases of the pronator-round syndrome, carpal tunnel syndrome, and cervical spondylosis.
(1) pronatorial round muscle syndrome: the pronated round muscle directly compresses the median nerve, causing the main trunk of the median nerve to be affected. The symptoms are mainly the function of the thumb to the palm, the sensory disturbance of the three sides of the temporal side and the elbow. And the proximal part of the pronator is tender, but the interosseous anterior nerve compression syndrome has no sensory disturbance.
(2) Carpal tunnel syndrome: The internal structure of the carpal tunnel leads to compression of the median nerve, which is mainly characterized by three-and-a-half finger palmar sensory disturbances on the lateral side of the hand; thumb-to-palm dysfunction, intermuscular muscle atrophy, and wrist center The nerve Linel sign is positive, and the wrist sign is positive. Therefore, it is easier to distinguish from the interosseous anterior nerve compression syndrome.
(3) Cervical spondylosis: mainly for nerve root type compression, there may be pain in upper limbs, discomfort of acidulence, muscle atrophy, lack of flexible finger movements, difficulty in fine movements, and cervical spondylosis may be affected by nerve roots. Obstruction, weakened muscles and muscle atrophy, and sputum reflexes have also changed. For those suspected of having cervical spondylosis, X-ray films and MRI have positive findings, which can be differentiated from interosseous anterior nerve compression syndrome.
