The term nerve compression syndrome is used to describe disease symptoms that result in functional limitations or total loss of function due to chronic pressure damage to peripheral nerves at specific insertion sites and bottlenecks. There are more than ten different known bottlenecks on the human body that can lead to a corresponding nerve compression syndrome with sometimes very painful and serious consequences. The functional limitations 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?
Nerve compression syndrome is an impairment in the function of one or more peripheral nerves that results from sustained physical pressure on the nerve. It usually involves natural constrictions between two muscles or feed-through grooves at joints and bones, where blood vessels and tendons usually run in addition to nerves. Far more than ten different neuralgic sites are known where nerve compression syndrome can occur, affecting sensory and motor impairments. The sometimes very painful functional impairment or total loss of function of the affected nerve occurs due to sustained physical pressure as the surrounding tissue swells and takes up space due to inflammatory processes or other reasons. As long as the nerve is not permanently damaged by the sustained compression, such nerve compression syndrome is partially or completely reversible. In principle, blood vessels running parallel to the nerves may also be affected, so that the conduction of arterial or venous blood may be impaired.
Causes
There are a variety of causes and complexes of causes that can lead to nerve compression syndrome. At narrow, bony passage sites such as the carpal tunnel at the junction of the forearm and the carpus on the flexor side of the hand, overuse can trigger inflammatory reactions that can cause swelling of the surrounding structure and compress the median nerve. This is then known as carpal tunnel syndrome, which is quite common. In some cases, degeneration or tissue neoplasms of the bony structure, such as so-called ganglions, can also exert pressure on the nerve due to spatial stress. A nerve compression syndrome can also form as a result of the muscle building up too quickly. This is the case when nerves are compressed in their course between muscles by the spatial stress of muscles that are rapidly increasing in strength. To a certain extent, a corresponding genetic disposition can also promote the development of nerve compression. This is always the case if there are other known cases of nerve compression within the family.
Symptoms, complaints, and signs
In an emerging nerve compression syndrome that is still in its early stages, the sensory system is usually the first to be affected. This means that numbness and other sensory deficits manifest, which may be accompanied by tingling on the skin (formication). Motor disturbances usually present themselves only when the compression of the nerves becomes more severe. The sensory and motor disturbances may be accompanied by considerable pain. In extreme cases, there is a complete failure of the innervated muscle parts because the motor nerve fibers can no longer deliver contraction signals to the muscle cells. Symptomatic of motor disorders are loss of strength and rapid breakdown of muscle tissue. The resulting limitations of movement depend on the location of the nerve compression syndrome.
Diagnosis and disease progression
Most nerve compression syndromes can already be identified from the patient’s described symptoms (history). To confirm the diagnosis, muscle strength testing and tests of touch sensations such as sharp, dull, cold, hot, and the like are available. In many cases, measurement of nerve conduction velocity is useful. The course of a nerve compression syndrome depends on how the constricting structures develop. If there is inflamed tissue causing the compression, the nerve compression syndrome may resolve on its own once the inflammation is resolved and the tissue is decongested.In most other cases, if left untreated, irreversible damage to the nerves occurs, resulting in permanent failure and breakdown of the innervated muscle areas and permanent sensory impairment.
Complications
Complications arising from nerve compression depend on the severity of compression of the nerve and the causative factors. If compression of the affected nerve resolves with or without treatment and the nerve is not already irreversibly damaged, the nerve compression syndrome may resolve completely with recovery of the original motor and sensory abilities. Often, tendons or ligaments also run in the constrictions for the physical passage of nerves and blood vessels, which can become inflamed and then swell themselves. In some circumstances, this is also true of the surrounding tissues, so that the original bottleneck leads to compression of the sensitive nerves, typically causing nerve compression syndrome. If left untreated, the motor or sensory nerve may be irreversibly damaged, such that symptoms of limited sensory sensation, such as numbness, and limited motor function do not resolve despite correction of the nerve compression. Naturally, there are about ten different known implementation sites – mostly near joints – from which a nerve compression syndrome can originate. In isolated cases, nerves may also be compressed outside of the known narrowing sites. For example, nerves that pass through two or more muscle areas from rapidly built muscle mass, as is desired in some extreme forms in bodybuilding, can be compressed by the muscles in such a way that nerve compression syndrome can result. If left untreated, there is a risk of irreversible sensory and motor deficits.
When should you see a doctor?
Numbness or sensory disturbances are signs of an existing irregularity that should be evaluated by a physician. If there is a lack of sensation, hypersensitivity to touch, or tingling on the skin, the affected person needs medical clarification of the symptoms. A decrease in physical performance, a reduced ability to cope with stress, and restrictions in mobility should be presented to a physician. In some cases, the complaints spread further or lead to a total loss of function. A physician is needed so that clarification of the cause can take place and a treatment plan can be developed. If there is impairment of the muscular system, the disease is already advanced. Pain, stiffness or a relieving posture of the musculoskeletal system indicate the need for medical care. Incorrect postures, incorrect stresses on the body and swelling should be discussed with a doctor. If joints can no longer be stretched or bent as usual, there is cause for concern. A doctor is needed to prevent permanent damage to health or the development of secondary diseases. If gait unsteadiness, an increase in minor accidents or falls, and emotional abnormalities become apparent, a doctor should be consulted. In cases of anxiety, mood swings, rapid changes in behavior, or withdrawal from social life, there are often underlying conditions for which treatment is needed.
Treatment and therapy
A nerve compression syndrome is always based on a primary disease that has been identified as the trigger of the symptoms. Therefore, treatment is primarily aimed at remedying the causes of the compression. Possible therapies cover a wide spectrum. Therapy may mean a simple instruction to change a habit or it may require surgical intervention. For example, wearing a wristwatch strap too tightly 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 wearing a less tight bracelet can correct the problem, in many cases the affected joint regions are immobilized by splints or bandages. Conventional or minimally invasive surgical interventions are considered the last resort if conservative treatment methods have failed to achieve the desired improvements. The primary goal of surgical interventions is always to eliminate the pressure load on the corresponding nerve so that it can regenerate.As the nerve regenerates through decompression, the discomfort also disappears.
Outlook and prognosis
Nerve compression syndromes can be treated surgically. Usually, the nerve recovers completely, insofar as the damage has not been present for too long. The prognosis is also based on the type of nerve compression. Carpal tunnel syndrome can be effectively treated both surgically and by various self-help measures. Loge de Guyon syndrome can already be treated by immobilizing the wrist with the aid of a suitable splint. Medication can provide additional relief from the symptoms. The quality of life is limited, especially during the acute pain phase. As soon as the nerve compression syndrome has been surgically repaired, the complaints also disappear. In most cases, complete recovery of the nerve is achieved. Full weight-bearing is only possible again after a few weeks. Until then, the patient may experience various limitations. If the nerve compression syndrome is treated early, the prognosis is relatively good. If the nerves are significantly damaged, deficits may persist. The patient may then be damaged for life and suffer from persistent pain, limited mobility, and nerve dysfunction. Life expectancy is not limited by the condition. The exact diagnosis must be made by a specialist in nerve diseases or the surgeon in charge.
Prevention
Preventive measures to minimize the risk of suffering nerve compression syndrome mainly refer to a critical observation from time to time of one’s habits that could lead to nerve compression. These include, for example, habits such as bracing the left elbow during long car rides or constantly resting the hand on the edge of the table when operating the computer mouse. Such considerations are especially important at the onset of the first signs, so that changes in unfavorable habits can be made soon enough to prevent worsening of the syndrome.
Follow-up
Follow-up care for nerve compression syndrome is particularly important for two reasons. First, it is important to support the regeneration of the stressed nerves in the best possible way. Secondly, the avoidance of incorrect posture should prevent the recurrence of compression of the sensitive nerves. Incorrect strain and posture as common causes are important topics in the context of efficient aftercare. In this context, attention must be paid to ergonomics at the workplace as well as to healthy posture and movement patterns in everyday life. In addition to the treating neurologist, orthopedist or family doctor, the physiotherapist or rehabilitation sports instructor can also provide help and advice. Occupational health advice is also often very helpful. Muscular balance in the body and 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 relieved with targeted massages. For patients with diagnosed or treated nerve compression syndrome, a back-friendly position in bed is also important. When purchasing a mattress, therefore, it is important to match it precisely to what the patient’s cervical, thoracic or lumbar spine require in order to support the patient in a way that is gentle on the nerves.
What you can do yourself
Nerve compression syndrome is a complaint amenable to self-help by the affected patient in many cases. Because 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 overuse, an appropriate change in behavior can also help to relieve or even eliminate the pain, tingling or numbness. 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 physical therapist. Often, the basics of targeted training or healthy postures are also learned during rehabilitation, physiotherapy or a special back school. Nerve compression syndrome can basically be alleviated in everyday life in two ways.On the one hand, this is possible by adopting a gentle posture every now and then in order to relieve the affected areas. An example of this is the stepped position with regard to the lumbar spine. The second way is to strengthen weak muscles and stretch shortened muscles. In this way, muscular imbalances are corrected and the body is straightened into its physiological posture. This is the posture in which pressure on the intervertebral discs is minimized to the best possible degree, so that constriction of nerves by disc tissue can be prevented.