Nerve compression syndrome

Under the term Nerve compression syndrome Disease symptoms are summarized which lead to functional restrictions or total loss of function due to chronic pressure damage to peripheral nerves at certain implementation points and bottlenecks. More than ten different bottlenecks in the human body are known which can lead to a corresponding nerve compression syndrome with sometimes very painful and serious consequences. The functional restrictions are reversible as long as the chronic pressure load has not yet caused permanent anatomical changes or lesions of the nerve.

What is Nerve Compression Syndrome?

Under a Nerve compression syndrome is understood to be a functional impairment of one or more peripheral nerves, which is caused by sustained physical pressure on the nerve. Mostly natural bottlenecks between two muscles or ducts in joints and bones are affected, in which blood vessels and tendons run in addition to the nerves.

Well over ten different neuralgic locations are known at which a nerve compression syndrome can occur, which can affect sensory and motor impairments. The sometimes very painful functional impairment or the total loss of function of the affected nerve comes about through persistent physical pressure, because the surrounding tissue swells up due to inflammatory processes or other reasons and takes up space.

As long as the nerve is not permanently damaged by the sustained compression, such a nerve compression syndrome is partially or completely reversible. In principle, blood vessels running parallel to the nerves can also be affected, so that the conduction of arterial or venous blood can be disturbed.

causes

There are a multitude of causes and complex causes that can lead to nerve compression syndrome. At narrow, bony ducts such as the carpal tunnel at the transition from the forearm to the wrist on the flexor side of the hand, excessive strain can trigger inflammatory reactions, which can lead to swelling of the surrounding structure and compress the median nerve.

It is then the very common carpal tunnel syndrome. In some cases, degenerations or new tissue formation in the bony structure, such as so-called transverse legs (ganglia), can exert pressure on the nerve due to space occupation. Nerve compression syndrome can also be caused by building muscle too quickly.

This is the case when nerves are compressed in their course between the muscles by the space required by the muscles, which are rapidly increasing in strength.

To a certain extent, a corresponding genetic disposition can also favor the development of nerve compression. This is always the case when other cases of nerve compression are known within the family.

Symptoms, ailments & signs

In the case of an emerging nerve compression syndrome that is still in the early stages, the first thing that is usually affected is the sensory system. This means that numbness and other sensory deficits manifest themselves, which can be accompanied by tingling on the skin (pins and needles). Motor disorders usually only appear when the nerves are compressed.

The sensory and motor disorders can be accompanied by considerable pain.In extreme cases, the innervated muscle parts fail completely because the motor nerve fibers can no longer send contraction signals to the muscle cells. Symptomatic of motor disorders are loss of strength and the rapid breakdown of muscle tissue. The resulting restrictions on movement depend on the location of the nerve compression syndrome.

Diagnosis & course of disease

Most nerve compression syndromes can be recognized by the patient's symptoms (anamnesis). A check of muscle strength and tests of touch sensations such as pointed, dull, cold, hot and the like are available to confirm the diagnosis. In many cases, measuring nerve conduction velocity is useful.

The course of a nerve compression syndrome depends on how the constricting structures develop. If inflamed tissue is the cause of the compression, the nerve compression syndrome can regress on its own after the inflammation has been resolved and the tissue has decongested. In most other cases, if left untreated, irreversible damage to the nerves occurs, resulting in permanent failure and degradation of the innervated muscle parts and permanent sensory impairment.

Complications

Complications from nerve compression depend on the severity of the compression of the nerve and the factors causing it. If compression of the affected nerve resolves with or without treatment and the nerve has not already been irreversibly damaged, the nerve compression syndrome can regress completely and the original motor and sensory abilities can be restored.

Often, tendons or ligaments run in the constrictions for the physical passage of nerves and blood vessels, which can become inflamed and then swell themselves. This may also apply to the surrounding tissue, so that the original bottleneck leads to compression of the sensitive nerves and typically causes a nerve compression syndrome.

If left untreated, the motor or sensory nerve can be irreversibly damaged, so that the symptoms of restricted sensory sensations such as numbness and restricted motor skills do not recede despite the removal of the nerve compression. Naturally, around ten different penetration points - mostly in the vicinity of joints - are known from which a nerve compression syndrome can start.

In individual cases, nerves can also be compressed outside the known constrictions. For example, nerves that pass through two or more muscle groups of rapidly built-up muscle mass, as is sometimes desired in extreme form in bodybuilding, can be pressed by the muscles in such a way that a nerve compression syndrome can develop. If left untreated, there is a risk of irreversible sensory and motor deficits.

When should you go to the doctor?

Numbness or loss of sensation are signs of an existing irregularity that should be investigated by a doctor. If there is abnormal sensation, hypersensitivity to touch or a tingling sensation on the skin, the person concerned needs a medical clarification of the symptoms. A doctor should be presented with a decrease in physical performance, a lower level of resilience and restrictions in mobility.

In some cases the symptoms spread further or lead to a total failure of the functions. A doctor is needed to clarify the cause and create a treatment plan. If the muscular system is impaired, the disease is already advanced. Pain, stiffening or a relieving posture of the musculoskeletal system indicate the need for medical care. Bad posture, incorrect loads on the body and swelling should be discussed with a doctor.

If joints can no longer be stretched or buckled as usual, there is cause for concern. A doctor is required so that no permanent health damage occurs or secondary diseases develop. If you experience unsteadiness, an increase in minor accidents or falls, or emotional abnormalities, a doctor should be consulted. Fears, mood swings, rapid changes in behavior or withdrawal from social life are often the basis of illnesses that require treatment.

Treatment & Therapy

A nerve compression syndrome is always based on a primary disease that has been identified as the cause of the symptoms. Treatment is therefore primarily aimed at eliminating the causes of the compression. Possible therapies cover a wide spectrum. Therapy can be a simple instruction to change a habit or require surgery.

For example, a wristwatch that is too tight can cause what is known as Wartenberg syndrome, a pressure lesion of the radial nerve on the extensor side of the wrist. While in this case taking off the watch or a less tight bracelet can solve the problem, the affected joint regions are often immobilized by splints or bandages.

Conventional or minimally invasive surgical interventions are considered the last resort if the desired improvements could not be achieved with conservative treatment methods. The primary goal of surgical interventions is always to relieve the pressure on the nerve in question so that it can regenerate. With the regeneration of the nerve through decompression, the symptoms also disappear.

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Outlook & forecast

Nerve compression syndromes can be treated surgically. Usually the nerve recovers completely, unless the damage has been around for too long. The prognosis is also based on the type of nerve compression. Carpal tunnel syndrome can be treated effectively both surgically and using various self-help measures. Loge de Guyon syndrome can be treated by immobilizing the wrist using a suitable splint. Medicines can provide additional relief from the symptoms. The quality of life is particularly limited during the acute pain phase. Once the nerve compression syndrome has been surgically corrected, the symptoms will also go away. In most cases, this results in complete recovery of the nerve.

A full load is only possible after a few weeks. Until then, various restrictions can arise for the patient. If the nerve compression syndrome is treated early, the prognosis is relatively good. Failures can persist if the nerves are clearly damaged. The patient may then be damaged for a lifetime and suffer from persistent pain, restricted mobility and nerve disorders. Life expectancy is not limited by suffering. The exact diagnosis must be made by a specialist in nerve disorders or the responsible surgeon.

prevention

Preventive measures to minimize the risk of developing nerve compression syndrome mainly relate to critical observation from time to time of one's habits that could lead to nerve compression. This includes, for example, habits such as supporting the left elbow during long car journeys or constantly supporting the hand on the edge of the table when using the computer mouse. Such considerations are especially important when the first signs appear, so that changes in bad habits prevent the syndrome from worsening early enough.

Aftercare

Follow-up care for nerve compression syndrome is particularly important for two reasons. On the one hand, it is important to optimally support the regeneration of the stressed nerves. On the other hand, avoiding bad posture should prevent a renewed compression of the sensitive nerves.

Incorrect strain and poor posture as frequent causes are important issues in the context of efficient aftercare. In this context, attention must be paid to ergonomics at the workplace as well as to a healthy posture and movement sequences in everyday life. In addition to the treating neurologist, orthopedic surgeon or family doctor, help and advice are also provided by the physiotherapist or rehabilitation sports teacher. Occupational medical advice is also often very helpful.

The muscular balance in the body or the reduction of imbalances play an important role in aftercare. Strengthening weak muscles (for example in the abdomen or upper back) is just as important in this context as stretching shortened muscles, which often affect the chest area or the back of the thighs. Tension can also be loosened with targeted massages.

For patients with diagnosed or treated nerve compression syndrome, a back-friendly position in bed is also important. When buying a mattress, it must therefore be tailored precisely to what the patient's cervical, thoracic or lumbar spine needs in order to position the person concerned in a nerve-friendly manner.

You can do that yourself

Nerve compression syndrome is a symptom that in many cases is accessible to self-help for the patient concerned. Since the constriction of the nerves in the spinal canal of the spine (lumbar, thoracic or cervical spine) is not infrequently caused by poor posture or excessive strain, a corresponding change in behavior can also help to relieve or even reduce the pain, tingling or numbness remove.

To ensure that exercises or postures are really good for the patient, self-help in everyday life should be discussed with the attending physician or physiotherapist. The basics for targeted training or healthy postures are often learned as part of rehabilitation, physiotherapy or a special back school.

Nerve compression syndrome can basically be alleviated in two ways in everyday life. On the one hand, this is possible by taking a gentle posture again and again in order to relieve the affected areas. An example of this is the stepped positioning with regard to the lumbar spine. The second way is to strengthen weak muscles as well as stretching shortened muscles. In this way muscular imbalances are balanced and the body is straightened into its physiological posture. This is the posture in which the pressure on the intervertebral discs is minimized as much as possible, so that constriction of nerves by intervertebral disc tissue can be prevented.