Nerve compression syndromes, also called entrapment neuropathies, happen when your nerves get squeezed or compressed. This causes pain, numbness, tingling and weakness along the length of the affected nerve. Nerve entrapment is common in your wrist, elbow, shoulder, and ankle. Understanding what causes nerve entrapment syndrome and being able to proactively manage your symptoms will help you stay healthy and pain-free.
In this comprehensive guide, we are going to cover the various types of nerve compression syndromes, their causes, symptoms, diagnostic tests, and treatment options, including both conservative care and potential surgery options.
What Causes Nerve Entrapment?
Nerves can become compressed or irritated as they pass through narrow channels, joints, or openings in your body. While these close connections aren’t typically a problem, they can become an issue under certain conditions. Here are a few common causes of nerve entrapment:
- Injury: Broken bones, sprains, and dislocations can affect nearby nerves. Scar tissue from trauma can also bind nerves. In the case of carpal tunnel syndrome, for example, the condition is often caused by wrist fractures.
- Arthritis: The swelling of your joints that happens when you have rheumatoid arthritis or bone spurs from osteoarthritis can pinch the adjoining nerves. Arthritis is a common cause of cubital tunnel syndrome (which is a nerve compression at the elbow causing hand numbness).
- Obesity: Excess weight presses on nerves crossing your wrist, elbow and ankle. Extra tissue fills spaces nerves pass through.
- Anatomic factors: Nerves passing through naturally narrow canals are more prone to compression. The carpal tunnel (the passageway in your wrist for nerves) is especially narrow.
- Pregnancy: Hormonal changes and fluid retention press on certain nerves like your median nerve (a major nerve in your arm and hand that delivers feeling to your thumb, index finger, middle finger, and part of your ring finger). Carpal tunnel syndrome is common during pregnancy.
- Occupational factors: Repetitive motions like typing irritate your nerves. Vibration exacerbates nerve inflammation. Peroneal nerve (the peripheral nerve that runs down your lower leg and provides sensory and motor functions to parts of your leg and foot) issues often occur in ballet dancers and deadlifters.
- Structural abnormalities: Having bone spurs, ganglion cysts, or swollen tendons next to your nerves can cause entrapment. Wrist ganglion cysts, for example, often compress the median nerve.
- Systemic illness: Diabetes, thyroid disorders, and autoimmune disease increase nerve irritation. Many cases of cubital tunnel syndrome are caused by rheumatoid arthritis.
- Poor posture: Constant shoulder protraction and leaning on your elbows compresses your nerves. Slouching aggravates thoracic outlet syndrome (which is nerve or vessel compression in your upper chest).
Eliminating the source of compression through conservative treatment (non-surgical or non-invasive medical care) or surgery will help your nerves to glide freely without obstruction or irritation. To get started on the nerve entrapment treatment, your healthcare professional will start by identifying causes and helping you get rid of aggravating activities.
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Common Areas of Nerve Entrapment
While nerves can become entrapped almost anywhere in your body, some areas are more commonly affected than others. Common sites of nerve entrapment include the following:
- Carpal tunnel syndrome: This happens when your median nerve is compressed at your wrist. It is the most common entrapment neuropathy.
- Cubital tunnel syndrome: You experience this when your ulnar nerve is compressed at your elbow. This is the second most frequent nerve compression site.
- Radial tunnel syndrome: This is a radial nerve compression at your elbow. If you have this syndrome, you will experience symptoms that spread down your forearm.
- Thoracic outlet syndrome: With a range of possible causes, you will experience this problem when your brachial plexus nerves are compressed at your shoulder.
- Suprascapular neuropathy: When your suprascapular nerve is entrapped near your shoulder it affects your shoulder mobility.
- Meralgia paresthetica: If your lateral femoral cutaneous nerve is compressed in your thigh, it will cause numbness over your thigh.
- Peroneal neuropathy: The compression of your peroneal nerve at your knee or ankle can cause foot drop (the inability to lift the front part of your foot and toes).
- Tarsal tunnel syndrome: When your posterior tibial nerve is compressed in your ankle, this painful condition can affect you.
What Is Cubital Tunnel Syndrome?
While we often hear about carpal tunnel syndrome, cubital tunnel syndrome is an all too common condition. This type of nerve compression happens when there is entrapment of the ulnar nerve as it courses through your elbow. The ulnar nerve runs through a passageway called the cubital tunnel located on the inner side of your elbow. When this tunnel becomes narrowed due to compression, it can irritate the ulnar nerve. Cubital tunnel syndrome is the second most common nerve compression condition after carpal tunnel syndrome.
Common cubital tunnel syndrome causes include:
- Leaning on your elbows for long periods: This compresses the nerve and puts pressure directly on the nerve passageway.
- Fluid retention or swelling: This is hard to avoid with conditions like pregnancy, diabetes, and hypothyroidism. Your nerves are very sensitive to small changes in space, and these conditions reduce the space for your nerves.
- Arthritis: Inflamed tissue from the elbow joint from osteoarthritis of rheumatoid arthritis puts pressure on the nerve and that joint swelling impinges nerves.
- Previous injuries: Elbow fractures or other injuries can cause scarring that binds to the nerve.
- Cubitus valgus elbow deformity: This curved shape reduces tunnel space.
- Ganglions or bone spurs: If located next to a nerve, any masses will crowd the area and put external pressure on it.
Cubital Tunnel Syndrome Symptoms
If you have elbow pain, you will want to look for some common symptoms:
- Pain, numbness, or tingling in your ring and little fingers
- Discomfort in your outer palm
- Ache in your back-of-hand region
Cubital Tunnel Syndrome Treatment
There are a range of treatment options, including
- Night splints
- Avoiding elbow pressure
- Surgery to decompress the nerve (cubital tunnel release procedure) in more severe cases
Signs and Symptoms of Nerve Entrapment Syndromes
Each type of nerve entrapment syndrome has similar traits because every variation of the condition involves nerve compression. Here are some syndromes:
- Aches, burning or sharp pain: Discomfort radiates along the course of the nerve.
- Numbness and tingling: Entrapped nerves fail to transmit normal sensations, which causes a “pins and needles” feeling or numbness.
- Weakness: When your nerves are unable to stimulate your muscles properly, it causes weakness and clumsiness. Having trouble with fine finger movements is especially common.
- Muscle atrophy: A lack of nerve causes your muscles to shrink and eventually waste away, shrunken muscles. This is often seen in the thenar muscles in cases of severe carpal tunnel syndrome.
- Reflex changes: Diminished or absent reflexes in the affected nerve are normal. In median nerve pathology, you will see reduced wrist movement.
- Sensitive skin: Nerve irritation makes your skin hypersensitive to touch and sometimes even a light touch can be painful.
Symptoms are often exacerbated by certain movements that further compress your nerves. A flareup of nighttime symptoms is common as your nerves swell up when extended for long periods.
As with all conditions, it is essential to see a healthcare professional for a proper diagnosis. Nerve conduction studies help confirm the diagnosis.
When you see your doctor, several tests such as MRIs and X-Rays will help to diagnose nerve compression:
- Medical history: It is important to explain past injuries, any recent accidents, repetitive activities, and chronic health conditions to help your doctor identify contributing factors.
- Physical exam: Weakness, atrophy, and sensory changes can be signs of nerve pathology. Tinel’s sign (tapping the nerve area to check for tingling sensations) and Phalen’s test check (flexing your wrists to evaluate movement) for carpal tunnel syndrome.
- Nerve conduction study: This will measure how fast signals travel through your nerve to detect the level of nerve damage. Your doctor will compare your affected and unaffected limbs.
- Electromyography: By recording the electrical activity of your muscles, a healthcare professional can determine if the muscles supplied by a nerve are functioning abnormally.
- MRI or ultrasound: This test views your anatomical structures, masses, and any possible anomalies that can contribute to nerve compression and visualise nerve swelling.
- X-rays: To see any possible joint damage or old fractures, this test will help detect arthritis or bone spurs aggravating nerves.
The combination of reported symptoms, physical exams, and electrical studies allows your healthcare professional to pinpoint which nerve is affected and find the exact location of the entrapment. This will help to guide your treatment.
If you have mild to moderate nerve compression, there are a range of non-invasive treatment options, such as the following:
- Bracing: Splints or braces immobilise and rest the affected area to calm nerve irritation. This is especially effective for elbow compression. Note that if you’re given a brace, it should be worn regularly for the best results.
- Medication: Oral steroids or non-steroidal anti-inflammatory drugs (NSAIDs) reduce inflammation. If oral treatments aren’t effective, your doctor may move on to steroid injections.
- Physical therapy: Stretching, massage, and gentle strengthening exercises can ease impinging structures and improve joint mobility.
- Nerve gliding: Exercises that gently move your nerves through their range of motion will help to free them. These should be done regularly throughout the day.
- Ice or heat therapy: Alternating ice and heat compresses will reduce swelling and improve blood flow around nerves. Like all treatments, it is important to apply the treatments consistently.
- Corticosteroid injection: Powerful anti-inflammatory medication offers powerful short-term benefits.
- Lifestyle changes: Losing weight, maintaining proper ergonomics, and making recommended activity modifications will take the pressure off your nerves. This is often done alongside occupational therapy.
How Long Does Nerve Entrapment Syndrome Last?
In mild to moderate cases, proper treatment will have you feeling back to yourself within three to six months. If your symptoms are moderate to severe or your condition fails to improve, surgery may be needed.
If non-invasive treatments aren’t able to relieve your nerve compression, surgical options include the following:
- Neurolysis: This will free scar tissue from around the nerve. It is performed endoscopically or as open surgery.
- Nerve decompression: This widens bony, fibrous canals constricting nerves and relieves pressure points, which makes it a common option for carpal and cubital tunnel release.
- Transposition: Your surgeon can reposition your nerve away from the compressive surfaces. This is commonly done for the ulnar nerve.
- Removal of compressive lesions: By exercising ganglion cysts or abnormal bands of tissue impinging nerves, your surgeon can eliminate the effect caused by the mass.
- Joint stabilisation: This will fix the unstable or displaced joints that are aggravating nearby nerves.
Surgery is highly effective at relieving nerve compression, with success rates over 90% in many studies. Post-surgery recovery will involve hand therapy and gradual strengthening over two to three months. With proper treatment, the recurrence of symptoms is uncommon.
Preventing Nerve Compression
In some cases, you can successfully prevent nerve compression. Some proactive measures that may help reduce your risks of developing nerve entrapment include the following:
- Losing weight if overweight: Having extra weight strains nerves and reduces compressive forces.
- Use care during activities: Use proper form, take breaks, and limit repetitive motions in sports or at work.
- Maintain good posture: Avoid prolonged postures like crossing your legs and leaning on your elbows. Regardless of your posture, change positions frequently.
- Use braces: Bracing during strenuous activity supports your vulnerable joints and protects them from injury.
- Watch your blood sugar: Maintaining optimal blood sugar levels is key if you’re diabetic. High glucose damages nerves.
- Use a splint: Wearing well-fitted wrist splints at night will keep your wrists neutral and keep your carpal tunnel open.
- Don’t overload: Avoid carrying heavy bags that compress nerves and instead use backpacks instead of shoulder bags.
While not always preventable, paying attention to early symptoms of nerve compression allows early intervention before permanent nerve injury occurs. This gives the best chance of full recovery.
Nerve Entrapment Syndrome: Takeaway Message
Nerve entrapment or compression syndromes occur when nerves get squeezed, usually in confined anatomical areas. This results in radiating pain, numbness, tingling and weakness in the nerve distribution area. Common entrapment sites in your body are the wrist, elbow, shoulder, thigh and ankle. Risk factors include a job or hobby requiring repetitive motion, trauma, arthritis, diabetes, anatomical constraints, and obesity. Non-surgical treatments like braces, corticosteroid injections and modifying activities can help alleviate mild cases. Otherwise, surgery to decompress nerves may be warranted.
Paying attention to warning symptoms is key. Getting early treatment before your nerves become permanently damaged will give you the best opportunity for recovery and quick recovery to normal nerve function. While nerve compression syndromes can be challenging to manage, a proper diagnosis and tailored treatment plan will make a world of difference. Being proactive leads to the most favourable results. With today’s technologies and surgical techniques, even severe nerve compression can be addressed effectively if caught early.
Getting Treatment for Nerve Entrapment Syndrome in Singapore
If you are dealing with pain, don’t want another day. Our expert team in our Singapore clinic can offer you life-changing results. We also specialise in ankle injury treatment and has wrist injury doctors onboard to treat carpal tunnel syndrome or other injuries.
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About the Author
Dr James Tan is a highly skilled orthopaedic surgeon who has more than 10 years of experience in sports surgery and exercise medicine. He is a member of the elite Asian Shoulder and Elbow Group and a founding member of the Singapore Shoulder and Elbow Surgery Society.
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