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Peripheral Nerve Entrapment

As nerves leave the spine, they will course through the body and are vulnerable to compression or entrapment anywhere along its course. The nerves can be chronically compressed through repetitive activities or trapped by acute injuries, causing swelling.

Common nerve entrapment syndromes are carpal tunnel syndrome from compression of the median nerve, causing nerve pain in your hand; meralgia paresthetica from compression of the lateral femoral cutaneous nerve, causing pain in your thigh; piriformis syndrome, causing pain commonly called sciatica from compression of the sciatic nerve by the piriformis muscle; and cubital tunnel syndrome from compression of the ulnar nerve at the elbow, causing pain in your forearm and hand.   

Symptoms

Every nerve has a specific job. That job may be to help a muscle move, transmit sensation back to your spinal cord and brain, or both. If a peripheral nerve becomes injured, compressed or trapped, it may prevent you from being able to do a particular function such as move your fingers or toes, or may cause pain in the distribution of that nerve. You may experience numbness and/or pain. The pain is usually described as burning, sharp, stabbing or tingling.   

Causes

Peripheral nerve entrapment neuropathy is caused by irritation or injury to a peripheral nerve anywhere along its course. Pressure on the nerve reduces blood flow to that nerve, causing injury. The distribution of your symptoms and the muscle affected will help your physician understand where the nerve is getting compressed.

Nerves are vulnerable to compression from repetitive activities (such as typing, affecting the median nerve in carpal tunnel syndrome; or excessive cycling, affecting the pudendal nerve and causing pudendal neuralgia), from swelling associated with arthritis or sprains (such as an ankle sprain, affecting the posterior tibial nerve and resulting in tarsal tunnel syndrome), from scar tissue trapping a nerve (such as what happens with some pelvic surgeries, leading to ilioinguinal neuralgia), from tumors, etc.  Although it may not cause compression itself, some chronic diseases such as diabetes make peripheral nerves more vulnerable to injury with compression.   

Treatments

Treatment for pain associated with peripheral nerve entrapment syndromes may include a referral to a pain management specialist. At the JLR Center for Pain Medicine, you and your physician will work together to design your treatment plan. On the initial visit, your physician will conduct a thorough history and physical examination to determine the exact nerve that is being compressed or injured, where it is being injured or compressed, and what is causing it. After that, with your input, a treatment plan will be devised. 

Your treatment plan may involve a combination of therapies. Your doctor may suggest some lifestyle modifications and physical therapy evaluation and treatment. If pain is not improved with some of these modifications, you and your pain management physician may discuss addition of medications designed to treat nerve pain. This may include a combination of anti-convulsants (nerve-stabilizing medications), anti-depressants which also work to stabilize the nerve, and topical patches and creams. 

Your doctor may also suggest administration of a nerve block to help alleviate some of the pain. If the pain persists, despite the initial treatment options, your provider may suggest a spinal cord stimulator trial or peripheral nerve stimulator trial.  Rarely is surgery required to alleviate symptoms.