Nerve compression

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:: Nerve compression
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Nerve compression

People get pain, numbness, and tingling in the arms and hands, as well as the feet and legs. What causes these problems? Often people do not have any injury or known cause. It comes on slowly usually, but can appear overnight. These are all signs and symptoms of possible nerve compression. When this keeps happening over time it is called chronic nerve compression. Usually at first, the symptoms come and go. If left untreated the symptoms over time may become more intense and more frequent. People usually wait until their symptoms are almost constant with disturbed sleep before they will see a doctor.

People wait to do something for a variety of reasons, "I wanted to avoid surgery", or "I hate seeing the doctor" are a few I hear fairly often. Sometimes people are afraid of the unknown. "I was afraid it might be something serious" was one nice lady's reason. I guess not knowing is better than knowing if it's going to be something serious. It sounds silly but it is a real fear for some folks.

Chronic Nerve compression means that pressure over time has been applied to the nerve to cause tingling, numbness then pain, and eventually weakness of the muscle supplied by the nerve. If you sit with your legs crossed for awhile that pressure may cause your leg to "go to sleep". The same will occur to your hand if you sleep in an awkward position. This amount of pressure is enough to stop blood flow to the nerve. This causes numbness and tingling temporarily, but only for a short time. Release of the pressure results in more severe tingling for a short time as circulation is reestablished and the nerve begins to conduct normal nerve impulses again.

If that pressure were maintained for a longer period of time, the nerve could suffer more severe damage. 'Saturday night palsy' refers to a syndrome where the person is drunk or doing drugs and falls asleep so deeply they don't feel the discomfort in their arm when they are sleeping on it. This results in a temporary loss of the radial nerve for several months. It is difficult to open the hand and the wrist 'drops'. If done for a long enough period of time it can result in permanent loss of these functions in the arms.

This is the difference between acute and chronic nerve compression. Shorter periods of time of nerve compression cause no permanent injury. If you let the compression go long enough, eventually you will go past tingling and numbness, into pain and weakness. This is why it is so important to address these issues right away before permanent injury can occur.

We try to reproduce the patient's symptoms in the clinic. For median nerve compression at the wrist, carpal tunnel syndrome, this is accomplished by bending the wrist toward the palm side. For ulnar nerve compression at the elbow, cubital tunnel syndrome, this is done by bending the elbow and holding it there for one minute. If the fingers tingle or the numbness worsens, nerve compression at those sites is suspected. Sometimes we push directly on the suspected site of compression with the expectation to create the sensory changes for the nerve supply to that area.

Treatment can be tricky. I have found that if the loss of sensation is less than two millimeters with a two point discrimination test, therapy is usually helpful. We use stretching, splinting, hands on mobilization, and nerve gliding to get rid of the problem.

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