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Mononeuropathy: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Mononeuropathy involves a violation of sensitivity and weakness in the zone of innervation of the affected nerve or nerves. The diagnosis is made according to the clinical picture, but it should be confirmed by electrodiagnostic tests.
Treatment of mononeuropathy is aimed at eliminating the cause, sometimes applying tires, applying NSAIDs, injecting glucocorticoids, and in severe cases of nerve impairment - surgical treatment.
[Causes of Mononeuropathy
Trauma is the most common cause of acute mononeuropathy. Excessive muscular activity or violent overdistension in the joint, as well as minor re-injuries (for example, working with a small tool, vibration of pneumatic hammers), can cause focal neuropathy. Continuous continuous pressure on the bony projections is fraught with compression neuropathy with damage to the superficial nerves (ulnar, ray, peroneal), especially in lean ones; such a squeezing is possible in a dream, in intoxication, cycling or anesthesia. Compression of nerves in narrow channels leads to tunneling neuropathy (for example, in the tunnel syndrome of the carpal canal). Compression of the nerve with a tumor, plaster bandage, crutches, with hyperostosis or prolonged compression while in one position (for example, when working in the garden) is fraught with compression paralysis. Neuropathy can cause hemorrhage in the nerve, exposure to cold or radiation, or direct tumor invasion.
Multiple mononeuropathy (mo noneuritis multiplex) usually occurs as a complication of systemic connective tissue disease (eg, nodular polyarteritis, systemic lupus erythematosus, Sjogren's syndrome, rheumatoid arthritis), sarcoidosis, metabolic disorders (eg, diabetes, amyloidosis) or infectious diseases (eg, lime disease, HIV infection, leprosy). Diabetes usually causes sensorimotor distal polyneuropathy.
Symptoms of Mononeuropathy
Typical for single and multiple mononeuropathy are pain, weakness and paresthesia in the innervation zone of the affected nerve or nerves. The defeat of the motor nerve begins with weakness without pain; damage sensitive - with violations of sensitivity without weakness. Multiple mononeuropathy often debuts asymmetrically; nerves can be affected all at once or gradually. A vast defeat of many nerves can simulate polyneuropathy.
Neuropathy of the ulnar nerve often develops as a result of trauma in the groove of the ulnar nerve with frequent support to the elbow or with asymmetric bone growth after a fracture in childhood (late paralysis of the ulnar nerve). The ulnar nerve can be squeezed in the cubital canal. Compression at the elbow level can cause paresthesia or loss of sensitivity in the little finger and on the palmar surface of the ring finger; weakness and atrophy of the adductor muscle of the thumb, the muscle that removes the little finger, the interosseous muscles. Severe, prolonged paralysis of the ulnar nerve leads to deformation of the hand like a bird's paw.
The syndrome of the carpal canal can be one- and two-sided. It develops as a result of the compression of the median nerve between the transverse superficial ligament of the wrist and the tendons of the flexor muscles of the forearm. Compression causes paresthesia and pain along the palmar surface. Possible pain in the forearm and shoulder, which usually intensify at night. There may be a violation of sensitivity on the palmar surface of the fingers I, II and III, as well as the weakness and atrophy of the short muscle that removes the thumb of the hand. Disturbance of sensitivity in this syndrome should be distinguished from dysfunction of the root of C5 with radiculopathy, if necessary, EMG is performed.
Neuropathy of the peroneal nerve is usually associated with compression of the nerve by the lateral surface of the cervix of the fibula. It is common among bedridden patients and lean people, who are accustomed to crossing their legs. It is manifested by the weakness of the extensor of the foot (impossibility to unbend the foot, withdraw it from the outside and sponge) and sometimes with a sensory deficit in the anterolateral surface of the shin and the rear of the foot.
Neuropathy of the radial nerve (synonyms: paralysis of the day off, paralysis of lovers, paralysis of the garden bench) is a consequence of pressing the nerve to the humerus, for example, when the hand lies for a long time on the back of an adjacent chair (for example, during intoxication or deep sleep). It manifests as a "dangling brush" (weakness of the extensors of the forearm, hand and fingers) and loss of sensitivity in the region of the first posterior interosseous muscle.
Treatment of Mononeuropathy
Treatment of mononeuropathy should be directed at the cause of the disease. With constant compression (for example, a tumor) it is an operation. Symptoms of transient compression are usually resolved after rest, warming, NSAIDs; should avoid the activities that cause them. Carpal tunnel syndrome is sometimes helped by injections of glucocorticoids. For all types, you can expect improvements from the use of corsets and tires. When the disease progresses, despite conservative treatment, surgical intervention should be considered.