Peripheral Minor Nerve Injuries

What is a minor nerve injury?

Minor nerve injuries are also known as entrapment neuropathies (entrapment – mild compression or elongation of a nerve, neuropathy something wrong with a nerve ) of which carpal tunnel is the most common along with cubital tunnel, radial tunnel syndromes in the arm, sciatica, piriformis syndrome and peroneal nerve syndrome being the most common in the lower limb. In the upper limb, it is also known as non specific arm pain (NSAP) and can be part of what was known as RSI or work related upper limb disorder (WRULD). These problems can often all be referred to by physiotherapists as neural problems also.

What are the symptoms?

They can manifest as ‘lines of pain’ or may occur as ‘clumps of pain’ along the course of a nerve. It may begin gradually with no history of trauma with symptoms that come and go initially and gradually over time become more present more of the time coming on more quickly and taking longer to ease possibly during computer work or driving.

These symptoms can also result from mild trauma which then subsequently cause changes to structures along the course of a nerve leading to the onset of symptoms eg from a slip or fall or a knock. They are often mistaken for a muscle or tendon strain eg biceps strain or a hamstring or calf strain. Often more than one structure along the course of a nerve is involved including either from the neck or the back and then other joints and / or muscles along its course along the arm or leg. These conditions are being increasingly known as multiple entrapment neuropathies recognising more than one area of the nerve is affected.

What is the cause?

Essentially what is happening is that at more than one site along the course of the nerve a mild compression or elongation is occurring reducing the blood flow to the nerve, reducing oxygenation to the nerve, leading to the nerve secreting pain causing inflammatory chemicals in the area. Pins and needles can also result from this compression. If the compression/ elongation is mild or slow enough the nerve structure can accomodate and no symptoms occur.

However, if it occurs more quickly or there is more than one site of compression / elongation, even though very mild, the sum of them causes the nerve to secrete these pain producing inflammatory chemicals in the tissues and also begins slowly to affect pain perception in the central nervous system. If compression is ongoing or more severe, then the nerve fibres themselves can be affected directly affecting nerve conduction causing a loss of sensation or muscle weakness. and possibly loss of tendon reflexes.

How can physiotherapy help?

Treatment and management of this condition can comprise of use of anti inflammatories and or anti inflammatory gel or cold packs locally to treat symptoms only, but long term will not deal with the underlying cause. Other measures are needed to increase circulation to the nerve, systemically with some form of cardiovascular exercise, even just walking, provided walking is not an aggravating factor.

Locally, at the site(s) of compression / elongation, treatment aimed at decompressing any sites of compression or alleviating areas of elongation of the nerve to locally improve blood circulation through the nerve through physiotherapy together with simple exercises also to increase local nerve circulation. Treatment duration is related to the period of symptoms if caught early alleviation of symptoms can be even in just a few treatments.

However, if symptoms have been ongoing for some time then treatment over a longer period is required for the nerve to recover more fully. Physiotherapists are trained to recognise, clinically diagnose and treat this condition.

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