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Chapter: Clinical Anesthesiology: Regional Anesthesia & Pain Management: Chronic Pain Management

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Entrapment Syndromes

Neural compression may occur wherever a nerve courses through an anatomically narrowed pas-sage, and entrapment neuropathies can involve sensory, motor, or mixed nerves.

Selected Pain Syndromes

ENTRAPMENT SYNDROMES

 

Neural compression may occur wherever a nerve courses through an anatomically narrowed pas-sage, and entrapment neuropathies can involve sensory, motor, or mixed nerves. Genetic factors and repetitive macrotrauma or microtrauma are likely involved, and adjacent tenosynovitis is often responsible. Table 47–8 lists the most commonly recognized entrapment syndromes. When a sen-sory nerve is involved, patients complain of pain and numbness in its distribution distal to the site of entrapment; occasionally, a patient may complain of pain referred proximal to the site of entrapment. Entrapment of the sciatic nerve can mimic a her-niated intervertebral disc. Entrapment of a motor nerve produces weakness in the muscles it inner-vates. Even entrapments of “pure” motor nerves can produce a vague pain that may be mediated by


afferent fibers from muscles and joints. The diag-nosis can usually be confirmed by electromyogra-phy and nerve conduction studies. Neural blockade of the nerve with local anesthetic, with or without corticosteroid, may be diagnostic and can provide temporary pain relief. Treatment is generally symp-tomatic with oral analgesics and temporary immo-bilization, whenever appropriate. Development of complex regional pain syndrome may respond to sympathetic blocks. Refractory symptoms may require surgical decompression.

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