Peripheral Nerve Compression/Injuries

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Peripheral Nerve Compression/Injuries

What is nerve compression? What are the symptoms and treatment methods?

Nerve compression, which occurs as a result of the tissues around the nerves putting pressure on the nerves; It manifests itself with pain, muscle weakness, numbness and tingling. Nerve compression, which negatively affects health and disrupts the comfort of life, can occur due to many reasons. Nerve compression, if left untreated, can cause loss of sensation and muscle loss over time.

What is nerve compression?

Nerves running between muscles and bones are cable-like structures that carry the signals they receive from the brain to the organs in the body. Nerves are also responsible for transmitting the sensations they receive from the skin, such as touch, cold and heat, to higher centers. Nerve compression occurs when tissues such as tendons, bones and cartilage in the human body put pressure on the nerves. Nerve compression is called entrapment neuropathy. 90% of entrapped neuropathies occur in the hand and are caused by ‘carpal tunnel syndrome’. Traumas, surgeries, and overdeveloped connective tissues that occur during fracture healing can also cause nerve compression. In addition, hernias, bone protrusions and narrowing of the spinal canal can also cause nerve compression.

What causes nerve compression?

There are many reasons for nerve compression, which occurs as a result of the pressure exerted by tissues on the nerves. Causes of nerve compression may include the following.

– A herniated disc is an important cause of nerve compression.
– Disc herniation, which occurs when the outer layer of the jelly-like substance between the vertebrae on the spine ruptures, can compress the nerves and nerve roots.
– Nerve compression may occur after trauma and injuries.
– Sitting and posture disorders are an important cause.
– Heavy sports activities may cause border compression.
– Congenital anomalies and genetic factors may be the cause of nerve compression.
– Diabetes, thyroid disorders, cysts and tumor formations can cause nerve compression.

How is nerve compression diagnosed?

The diagnosis of nerve compression can be made by the patient’s complaints, physical examination, electrophysiological examination and imaging methods. Especially in electromyography (EMG), electrical stimulation is given to the nerves to reveal whether the nerve is working or not. If there is a problem in the conduction of the nerves, its location and degree are determined. In addition, whether the stimulus reaches the muscle and the response of the muscle to these stimuli are also evaluated. During the EMG process, the signals coming from the muscles and nerves are transferred to the digital environment as data through a special device and electrodes. The digital data are interpreted by neurologists and evaluated for any abnormalities. Performing EMG consists of two stages. It is divided into two stages: surface EMG, in which the electrodes are glued to the skin, and needle EMG, in which the needle electrode enters the muscle. In the first stage, nerve conduction status is determined. For this purpose, a conductive material is applied to the patient’s arms or legs, recording cables are connected, and electrical stimulation is given through the stimulating electrode. Thanks to the recording cables, the data obtained is transferred to the computer, the data is processed digitally and reflected on the computer screen. In the second stage, a sterile needle is inserted into certain muscles, and the electrical activity of the muscles at rest and in contraction is reflected on the computer screen and examined by the doctor.

Is there a test for nerve compression?

EMG, which is performed to determine whether there is nerve compression, is a test used to measure the natural electrical activity of the muscles. Thanks to EMG, it is determined whether the cause of the disease is in the muscles or the nerves feeding the muscles. EMG is a method used to detect dysfunctions in nerves, to diagnose diseases affecting nerves and muscles, or to determine the severity of damage. In addition, areas where nerves are compressed can be detected thanks to MRI, which allows imaging of the body with the help of magnetic waves. Thanks to imaging, cysts that cause nerve compression, growths and edema on the joint surface or muscle are determined.

What are the symptoms of nerve compression?

Pain as a result of nerve compression is a defining feature. In some cases, pain may not occur. Nerve compression is manifested by numbness and tingling in the fingers and weakness during grasping. Additionally, excessive exposure to heat and cold, muscle weakness and sweating disorders may occur.

– Hand numbness that wakes you up at night,
– Edema in the area where nerve compression is seen,
– Pain or aching along the area where the compression occurs,
– Loss of power in advanced cases.
– Muscle stiffness while moving
– Characteristic deformations in hands and fingers

Are there different types of nerve compression?

The important known types of nerve compression are as follows:

– Carpal tunnel syndrome (nerve compression in the wrist)
– Herniated disc (nerve and nerve root compression on the spine)
– Cubital tunnel syndrome (ulnar nerve compression at the elbow)
– Peroneal nerve compression (nerve compression in the leg and knee)

Is there a treatment for nerve compression?

Treatment of nerve compression should be planned individually according to the patient’s condition and problem. After determining the area where the compression occurs, it may be necessary to rest the area where the compression occurs with the use of splints or tape, depending on the course of the pain. The physical therapy process and the medications given make the patient comfortable. Corticosteroid injections and analgesic medications should be taken on doctor’s advice. If the nerve compression continues to increase, if the inability to grasp objects or loss of sensation occurs, surgical treatment must be considered.

Is there a non-surgical treatment for nerve compression?

Depending on the condition of the nerve compression, it is decided whether surgery will be performed or not by neurosurgery evaluation and the requested EMG and some other tests.

What are the medications used for nerve compression?

Non-steroidal anti-inflammatories or corticosteroid drugs are prescribed by specialist physicians for nerve compression. Thanks to these medications, edema in the area where the nerve is compressed is reduced and inflammation is prevented.

Is it possible to exercise for nerve compression?

Specialist doctors should determine the exercises to be performed for nerve compression. Exercises should be defined according to the condition of the nerve compression and the person. Exercises performed unconsciously by patients can sometimes cause harm rather than benefit.

NERVE INJURIES

Nerves are transmission systems that allow messages from the brain to carry signals to various parts of the body and carry signals from various parts of the body to the brain. The nerve contains millions of fibers, and these fibers travel in groups within the nerve as cables wrapped in a protective sheath. This system, which carries the message in the form of cables, is surrounded by a protective insulation material.

Nerves are of two types: motor nerves, which carry messages from the brain to the muscles and control movements, and sensory nerves, which carry sensations such as pain, pressure and temperature from various parts of the body.

Nerves can be damaged by stretching, pressure and cutting. In tension and pressure injuries, the structure of the protective layer around the nerve is not damaged, but due to damage to the fibers, the conduction system is disrupted and the nerve becomes inoperable. In case of cut, both the nerve fibers and the protective layer around them are damaged. After damage, messages from the brain cannot be transmitted to the muscles and functions cannot be performed, or sensory signals received from various parts of the body cannot be transmitted to the brain.

When nerve fibers are damaged, the protective layer structure around them maintains its continuity. The part of the injured nerve endings up to the upper transmission station dies and dissolves itself. It ensures that the protective layer remains in the form of hollow tubes. After a while, the healing process begins. If there is no damage to the protective sheath or if the sheath has been repaired, the growth of the fibers continues through the empty tubes and healing is achieved up to the conduction end points (receptors) of the motor or sensory nerves. Nerves are the slowest healing tissue in the body. If the protective sheath structure is not repaired, the nerve endings that enter the healing process and continue to grow cannot find their way and form masses called neuroma at the nerve end. When pressure is placed on these masses, painful electrical impulses occur.

If the nerve is completely cut during the treatment, the two ends of the nerve are identified and the surrounding protective layer is repaired with as thin stitches as possible. The aim of the treatment is to ensure the continuity of the surrounding sheath tissue and to ensure that the nerve fibers entering the healing process find their way to their final transmission points. Nerve sheaths must be repaired carefully using microsurgical methods with as thin sutures as possible to avoid creating excess scar tissue and creating pressure on the nerve healing area. Especially at the hand and finger levels, the nerves become very thin and generally lie side by side with the vascular structures. When nerve injury is detected, injury to the vascular structures is very common. Since very thin stitches are used, plaster treatment is applied for 3 weeks to protect the repaired part.

Nerve sheaths are tried to be stitched to their original place with the help of the vascular structures on the nerve, but no matter how many attempts are made to surgically stitch them to their original place, the hollow tubes cannot always find their old place. It is not possible for millions of fibrils to find their original place.

If the wound is very dirty and will be left open, nerve suturing may not be performed during the first operation. If there is a nerve defect (deficiency), the continuity of the nerve is ensured by placing a nerve graft (part) taken from the leg.

After nerve repair, nerve fibers begin to grow 3-4 weeks later. Patient’s age, type of injury, smoking, etc. Although it depends on factors, fibers generally progress through the nerve tubes at an average of 1 mm per day. For this reason, sensory recovery may take between 1-2 months and 6-8 months, depending on the distance of the injury to the target. During this period, the patient should be careful not to injure the fingertip while touching the heat or doing work. While waiting for nerve recovery, the activity of the muscles stimulated by the nerve should not be lost.