Nerve compression syndrome

Overview

Nerve compression syndrome, also known as compression neuropathy or entrapment neuropathy, refers to a group of conditions that occur when a peripheral nerve is compressed or pinched, leading to impaired nerve function. This pressure can cause pain, numbness, tingling, muscle weakness, and other neurological symptoms depending on the nerve affected and the duration of compression.

Nerve compression syndromes are commonly seen in both the upper and lower limbs, with some of the most recognized forms including carpal tunnel syndrome, cubital tunnel syndrome, radial nerve palsy, thoracic outlet syndrome, and tarsal tunnel syndrome. These syndromes can significantly affect a person's quality of life, particularly if not diagnosed and managed promptly.

Causes

Nerve compression can result from a wide range of factors, including anatomical variations, repetitive use, trauma, inflammation, or other systemic conditions. The underlying mechanism involves sustained pressure on a nerve, which restricts blood flow and disrupts normal signal conduction.

Common Causes

• Repetitive motion: Frequent use of a joint or muscle group, especially in occupational settings

• Trauma: Direct injury or fractures that lead to swelling or misalignment compressing the nerve

• Anatomical abnormalities: Bone spurs, cysts, or tight anatomical passages (e.g., narrowed carpal tunnel)

• Inflammatory conditions: Rheumatoid arthritis, tenosynovitis, or soft tissue inflammation

• Obesity: Increased pressure on nerve pathways due to excess tissue

• Diabetes mellitus: Contributes to nerve vulnerability and delayed healing

• Pregnancy: Fluid retention and hormonal changes may temporarily compress nerves

Symptoms

The symptoms of nerve compression syndrome depend on the specific nerve involved and the severity of the compression. Generally, symptoms develop gradually and may worsen over time if not addressed.

Common Signs and Symptoms

• Pain: Localized or radiating pain along the course of the nerve

• Numbness or tingling: Often described as “pins and needles,” especially in the hands, arms, feet, or legs

• Muscle weakness: Difficulty gripping, lifting, or performing fine motor tasks

• Muscle atrophy: In long-standing cases, affected muscles may shrink from disuse

• Clumsiness or coordination loss: Particularly in hand-related compression syndromes

• Worsening symptoms at night: Especially in conditions like carpal tunnel syndrome

Diagnosis

Diagnosis of nerve compression syndrome is based on clinical evaluation, patient history, and diagnostic testing. The aim is to identify the location, severity, and cause of the nerve compression.

Clinical Evaluation

• Medical history: Symptoms, occupational exposure, repetitive movements, or trauma

• Physical examination: Includes motor and sensory testing, reflex checks, and provocative maneuvers (e.g., Tinel’s sign, Phalen’s test)

Diagnostic Tests

• Nerve conduction studies (NCS): Measure electrical signal speed along the nerve

• Electromyography (EMG): Assesses electrical activity in muscles to detect nerve injury

• Ultrasound: Used to visualize swollen or compressed nerves

• MRI or CT scans: Help detect structural abnormalities like tumors, herniated discs, or bony compressions

Treatment

Treatment for nerve compression syndrome focuses on relieving pressure on the nerve and managing symptoms. Conservative (non-surgical) treatments are usually tried first, with surgery considered for severe or persistent cases.

Conservative Management

• Activity modification: Avoiding repetitive movements and positions that aggravate symptoms

• Rest and splinting: Immobilization of the affected area to prevent further stress on the nerve

• Physical therapy: Strengthening, stretching, and nerve-gliding exercises

• Nonsteroidal anti-inflammatory drugs (NSAIDs): To reduce pain and inflammation

• Corticosteroid injections: Used in some cases to reduce swelling around the nerve

• Ergonomic adjustments: In the workplace or during daily tasks

Surgical Treatment

• Nerve decompression: Surgical release of the nerve from surrounding tissues (e.g., carpal tunnel release)

• Nerve transposition: Repositioning the nerve to reduce pressure (e.g., ulnar nerve transposition)

• Removal of compressive structures: Such as bone spurs or tumors

Surgery is generally effective in relieving symptoms, especially when performed early in the course of the disease. Postoperative rehabilitation may be needed to restore full function.

Prognosis

The prognosis for nerve compression syndrome is generally favorable, especially when diagnosed early and treated appropriately. Many patients respond well to conservative management, with symptoms resolving or significantly improving. However, prolonged or severe compression can result in permanent nerve damage and muscle atrophy.

Key factors that influence prognosis include:

• Duration and severity of compression: Early intervention improves outcomes

• Patient compliance: Following ergonomic and therapeutic recommendations enhances recovery

• Underlying health conditions: Diabetes and other comorbidities may complicate recovery

With timely treatment and rehabilitation, most individuals with nerve compression syndromes can return to normal activities and prevent recurrence through lifestyle adjustments and preventive care.