Peripheral nerve entrapment syndromes of the lower extremity

Abstract

Patients affected by peripheral nerve entrapment syndromes generally complain of paresthesias, pain, and/or motor weakness in the territory supplied by the involved nerve. Clinical manifestations can be divided into three stages: in stage I there are rest pain and intermittent paresthesias that are worse at night; in stage II paresthesias and numbness are constant and can occasionally be associated to muscle weakness; in stage III there are constant pain, muscle atrophy, and permanent sensory loss [ 10 ]. Symptoms depend on the internal anatomy of the affected nerve. Compression, stretching, and friction are the mechanisms causing peripheral nerve entrapment syndromes. On physical examination, changes in temperature or pain sensation and motor atrophy or weakness in the area of the involved nerve may be observed. Symptoms may be provoked or exacerbated by direct compression of the nerve or by changes in position of the extremity. Tinel‘s sign is often present, being evoked by percussion over the nerve that causes an electrical-like sensation, which radiates along the nerve and over its innervated territory. A suspected entrapment syndrome is generally confi rmed by conventional nerve conduction study and electromyography that allow differentiation of nerve entrapments from several other pathologies like ischemic mononeuropathies, generalized peripheral neuropathies, radiculopathies, or plexopathies [ 14 ].