Muscle and Nerve Disorders
A variety of muscle and nerve disorders cause weakness, numbness and pain that may progress to an incapacitating condition. These conditions may continue to worsen unless the cause is found and proper treatment is begun. Some of these conditions include:
- Polyneuropathies, also called peripheral neuropathy (disease of the nerves)
- Myopathies (disease of the muscles)
- Nerve compressions
- Myasthenia (disease of the connection of the nerve and muscle)
- Fibromyalgia (also called fibrositis), a condition of unknown cause
At the NeuroCenter, we have been very successful in the treatment of fibrositis. In addition, peripheral neuropathy and myopathies are studied extensively. The patient undergoes a diagnostic test called an electromyogram (EMG) that will help evaluate nerve and muscle function. This information helps inform a diagnosis and an effective treatment. A comprehensive approach to study these conditions is essential to reach a final diagnosis and find a suitable treatment.
Peripheral Neuropathy Pain
Peripheral neuropathy is due to the inflammation or other type of damage of the peripheral nerves. This condition can give rise to symmetrical pain in the distal part of the extremities. It occurs more often in the lower extremities than the upper extremities, causes moderate to severe burning pain in the feet, hands, or both and is associated with numbness and tinglin.
Sometimes the neuropathy is localized and the pain may be restricted to the area of the body where the damaged nerve fibers used to provide sensation. This condition may affect the lateral aspect of the thigh (meralgia paresthetica), leg, forearm, hand, or foot.
A subtle type of peripheral neuropathy may also give rise to some cases of restless leg syndrome. The condition sparks off movements of the legs to relieve a distressing tension and discomfort than besieged the patients mostly at night when they are in bed. Sometimes the symptoms may also occur during the day.
Neuropathy pain is treated by treating the cause when it is known. It can also be alleviated by decreasing the irritability of the nerves with medications. Nerve blocks may also help those patients who fail to respond to medications or have partial improvement with them. Following is a case study exemplifying how we diagnose and treat this condition. Please click on CASE STUDY.
Fibromyalgia causes pervasive, fatiguing pain in multiple areas, located on both sides of the body, where no demonstrable damage can be detected. It seems to be a chemical disorder and is often associated with fatigue and insomnia. Areas of the muscle may react forming painful muscle knots commonly referred to as trigger points. The chronic, tiring pain, may give rise to depression, which can worsen the disorder and create a vicious cycle.
Often a traumatic event like a car accident or work injury can trigger the beginning of the condition.
Fibroamyalgia can co-exist with other conditions such as nerve injuries, radiculopathies, arthritis, tendinitis. These dueling conditions end up fueling one another’s pain.
A thorough evaluation of all the factors involved is needed. Medications to improve chemistry of pain control, nerve irritability, and trigger point injections may be needed. Coexistent conditions must be treated in parallel.
Dr. Ketki Modi, a physiatrist at Swedish Covenant Hospital, says aerobic conditioning is crucial to reducing pain, and she works with patients to create a graded exercise program that helps them gradually build tolerance for exercise. She also emphasizes a program of stretching and yoga — which recent research suggests can be beneficial for many with fibromyalgia.
“If people are really tight and stiff, sometimes the musculoskeletal system isn’t working properly,” Modi says. “They may feel 50 percent better once they’re more flexible.”
Dr. Modi also works with her patients on stress management techniques and recommends clinical massage to help improve blood flow throughout the body and increase relaxation.
These injuries occur when a nerve is cut, for example by glass or metal during a car accident or by a knife during a stabbing. Generally, nerves injured in this manner are repaired by suturing the severed ends back together as soon as possible after the injury occurs. Delayed repair makes this surgery more difficult. Click here to read about PERIPHERAL NERVE SURGERIES.
Nerve Compression Injuries
These injuries occur when external pressure on an extremity damages a peripheral nerve. For example, patients may fall asleep with their arm draped over the back of a chair, resulting in a compression nerve injury of the upper arm. Compression injuries typically heal on their own, rarely requiring surgical repair. Click here to read about PERIPHERAL NERVE SURGERIES.
Ulnar neuropathy is the second most common nerve entrapment syndrome. It generally occurs due to compression of the ulnar nerve at the elbow. Less commonly it occurs at the level of the wrist. Often this compression is preceded with one or more episodes of minor elbow injuries. Sometimes these patients routinely rest the elbows on hard surfaces. Elbow pain, sensory loss of the little and ring fingers, and grip weakness are common complaints.
As for ulnar neuropathy syndrome, treatment generally begins with avoiding aggravating or causative activities, such as repetitive elbow trauma, compression of the elbow against hard surfaces, etc. Elbow padding is typically the next step. Patients who still do not improve are offered decompressive surgery. Click here to read about PERIPHERAL NERVE SURGERIES.
This entrapment syndrome occurs when the common peroneal nerve is compressed along its course around the fibular head, a bony structure found on the lateral aspect of the leg just below the knee. Like the ulnar nerve entrapment, trauma often predisposes to this entrapment syndrome. Typically a single traumatic event, rather that a series of minor injuries as in ulnar neuropathy, injures the peroneal nerve. A severe blow to the side of the knee, twisting the ankle (thus stretching the nerve), and prolonged recumbency with the knee against a hard surface are all common causes of peroneal nerve injuries in this location. These patients typically complain of pain in the lower leg, numbness on the top of the foot, and foot drop.
Patients who suffer from foot drop require ankle bracing until muscle strength returns. Those who have severe pain and/or weakness do not get better after a period of observation are candidates for decompressive surgery. Click here to read about PERIPHERAL NERVE SURGERIES.