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MERALGIA PARESTHETICA, Entrapment Neuropathy
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Carpal tunnel syndrome:…
MERALGIA PARESTHETICA
Types
Here, the exact cause is unknown
This is due to
- mechanical compression anywhere throughout the course of the nerve.
.
The common site of injury is
- at the exit of the nerve at the pelvis
This is commonly seen after
- orthopedic surgeries like anterior iliac crest bone grafting and
- anterior pelvic procedures and
- prone positioning for surgeries.
Clinical Features
This is characterized by
- pain,
- numbness and
- paresthesia (pins & needles)
along the anterolateral aspect of the thigh.
Diagnostic Test
If there is relief of pain and paresthesia after injecting local anesthetic, the diagnosis is clinched.
Treatment
Conservative
Idiopathic type:
improves by
- removal of the compressive agents,
- nonsteroidal anti-inflammatory drugs
- and local steroid injection
Iatrogenic type:
-
Operative
If pain persists in spite of the above treatment,
surgery is indicated.
The procedures include
- neurolysis or transection of the nerves.
- It is due to compression neuropathy or neuroma of
the lateral femoral cutaneous nerve
Entrapment Neuropathy
.
- Carpal tunnel syndrome: Median nerve at wrist.
,
- Tarsal tunnel syndrome: Posterior tibial nerve at ankle.
.
- Epicondylar tunnel syndrome: Ulnar nerve at elbow
.
- Meralgia peraesthetica: Lateral cutaneous nerve of thigh
about an inch inferior to the ASIS.
Incidence of peripheral nerve injuries
- Radial nerve is commonly injured.
- Ulnar nerve 30 percent.
- Median nerve 15 percent.
- Peroneal nerve.
- Lumbosacral plexus 3 percent.
- Tibial nerve
Quick facts:
It is difficult to evaluate a nerve injury immediately after a
severe trauma. However, typical attitudes and simple
screening test help clinch the diagnosis with reasonable
accuracy.Typical deformities
- Wrist drop → Radial nerve injury.
- Claw hand → Ulnar nerve injury.
- Foot drop → Lateral popliteal nerve injury.
- Ape thumb → Median nerve injury.
- Pointing index → Median nerve injury.
- Winging of scapula → Thoracodorsal nerve injury.
- Policeman tip → Brachial plexus injury.
Simple screening tests
- In ulnar nerve injury, loss of pain at tip of the little finger.
- In median nerve injury, loss of pain on the tip of index finger.
- In radial nerve injury, inability to extend the thumb
(Hitchhiker’s sign)
Quick facts: EMG
- Normal insertional activity immediately after section.
- Positive waves seen after 5-14 days.
- Denervation fibrillation after 14 days.
- Spontaneous fibrillation after 15-30 days of interruption.