Dr. John L. Michie
As a neuro-musculo-skeletal clinician, I frequently evaluate patients with a variety of nerve related issues. Many conditions arise from the spine due to disc bulges and/or protrusions, spinal stenosis secondary to degenerative joint and/or disc disease and spinal “misalignments” or the classic “pinched nerve” from some mechanical stress/injury or repetitive stress event like poor posture while working or excessive postural demands as in athletic endurance events (swimming, cycling, running, etc.) However, many nerve related issues present “outside” the spine and can confuse the patient and even the clinician as to the root cause.
Peripheral Nerve Entrapments can present with numbness, tingling, itching, burning and even aching in a specific region of the body that follows a nerve pathway. Peripheral Nerve Entrapments are frequently caused by muscle, ligament and/or fascial restrictions that are due to either over-use or improper use of certain muscles or muscle groups. For instance, a common postural imbalance is lumbar hyperlordosis and a protuberant abdomen. This imbalance will lead to weak abdominals and gluteus maximus muscles thus leading to anterior rotation of the pelvis and hyperlordosis (increased curve) of the lumbar spine. This in turn leads to increased tension of the lumbar erectors and shortening of the iliopsoas (deep hip flexors). With this common scenario, peripheral lumbar nerves can get entrapped by the iliopsoas muscle or even the inguinal ligament (ligament in groin area) thus leading to what is clinically known as “Meralgia Paresthtica” or entrapment of the Lateral Femoral Cutaneous Nerve and numbness or nerve irritation of the lateral hip and thigh.
Other such peripheral nerve entrapments that commonly present in clinical practice include Carpal or Ulnar Tunnel syndrome, Cubital Tunnel Syndrome, Thoracic Outlet Syndrome, Scalenus Anticus Syndrome, Pectoralis Minor Syndrome, .Pronator Teres Syndrome, Radial Tunnel Syndrome and in the lower body Piriformis Syndrome and even Tarsal Tunnel Syndrome. All of these “Syndromes” have a muscle/fasical origin and as delicate nerve course through specific muscles, if the muscle/fascial areas are improperly used they will in turn compress and “entrap” nerves leading to debilitating neuropathies and unwanted symptoms.
The initial Peripheral Nerve Entrapment that I will review is Carpal Tunnel Syndrome (CTS), one of the most common and often curable pathologies. The median nerve, which emanates from the cervical spine, travels through the scalenes, pectoralis minor, and transverse carpal ligament in the wrist. So, there are multiple entrapment or “crush” sites of this nerve syndrome. The term “double crush” neuropathy is frequently given to this pathology as the wrist is typically only one region of cause. In almost 80 percent of carpal tunnel cases, there is a double crush effect involving the contributing muscle group(s). With CTS, postural and repetitive stress patterns are typically at fault and will compromise the median nerve at both the anterior (front) neck muscles and the deep pectoral (chest) muscle. These muscles will become insidiously tightened and shortened causing nerve irritation and affect it down its path to the wrist, hand and fingers in a specific distribution (wrist, hand and thumb, index and middle finger as well as the outer portion of the ring finger). Surgical intervention is sometimes indicated (Carpal Tunnel Release) if neuropathy has progressed to the point of atrophy and loss of function but without addressing the root cause, even the surgical “cure” will only be short lived. Most cases resolve with addressing the root cause with conservative measures. Addressing the entrapment areas with chiropractic (adjustments to regions in the cervical spine, shoulder, wrist and hand), trigger point release therapy (dry needle therapy, electrical trigger point therapy, soft tissue mobilization/deep tissue massage, stretching) and corrective/stabilization exercises to re-pattern the weak, shortened muscles as well as kinesiotaping to assist the body to “remember” the corrective input from the therapy and exercises will all contribute to remediating this debilitating condition. Nutritionally, it is paramount to increase magnesium and vitamin B6 (muscle and nerve function), omega 3 fish oil and proteolytic enzymes (Protrypsin) (anti-inflammatory) and avoidance of inflammatory mediators such as gluten grains and dairy will all contribute to a healing environment for sustained benefit. MRI, if indicated, of the cervical spine, brachial plexus and the wrist/forearm region will uncover the area(s) of entrapment. Finally, with CTS cases, sleeping with a “Cock-up splint” for a few weeks and having ergonomic stressors addressed at work will all contribute to a successful long term resolution of this condition.