What is Nerve Impingement?

Nerve impingement or entrapment occurs when nearby bone – whether it be vertebrae or otherwise, impinge on the pathway of the nerve or the nerve itself resulting in neurological symptoms.

Nerve impingement typically only occurs on a single side unless it presents in the spine when caused by a disc or narrowing of the spinal foramen (gaps where the nerves exit the spinal cord). In the extremities it can occur at the elbow, knee, fibular, hips, wrists and shoulders.

It is more common if the patient has experiences trauma in the past. There can be feelings of the joint “Giving out”, decreased sensation of hot/cold, fine touch, sharp and dull as well as tingling, numbness or weakness. 

In the legs the most common nerve impingement is of the peroneal/fibular nerve which runs on the outside of your shin. When this nerve is impinged it can cause a foot drop where the food cannot lift the ball of their feet or toes. They may have pain in the knee or below, weakness in the movement of pulling the toes to the ceiling and a burning/tingling pain on the top of the foot.

The most common form of nerve impingement in the upper limb is of the median nerve. This is commonly known as carpal tunnel and affects 3% of the adult population, mostly female and between the age of 40 and 60 years old. Like nerve entrapment of the lower limb patients will experience neurological symptoms and weakness. Repetitive movements found in occupations such as admin (office work) and trades can increase the risk of carpal tunnel syndrome.

Assessment:

Firstly, your osteopath will look at the area of symptoms and the associated chain. For example, if it is the foot they will look at the foot, knee, hip and low back. They will assess range of motion, the nerve pathway and possibly perform a Tinel tap (taping the nerve to reproduce neural symptoms). They may refer you to a radiographer for imaging such as an x-ray if this was after an acute trauma, ultrasound to identify soft tissue lesions or scar tissue build up. In addition, general practitioners (GP’s) can perform motor conduction studies where they test musculature innervated by nerves in the same chain to identify what nerve may be impinged.

Lower limb neurological assessments will also be performed that identify reflexes, strength of muscles/nerves, light touch sensation of nerves, sharp and cold sensation of nerves. These tests will be performed on both sides to make sure it is an issue with the peripheral nervous system and not the central nervous system (spinal cord). 

Treatment:

Osteopathically your practitioner will work on decreasing tissue tension in the area – this includes muscles and ligaments. They will work on the joint itself as well to increase space and range of motion.

As the nerves begin in the spinal cord you may find your practitioner works on the entire chain (Neck, shoulder, elbow wrist or low back, pelvis/hip, knee and ankle). This can be done using a variety of techniques such as soft tissue, mobilisation, manipulation (if deemed appropriate) as well as more indirect techniques such as balance ligamentous tension, osteopathy in the cranial field and functional techniques. In addition, we may prescribe stretching, strengthening and nerve gliding exercises.

As we are a holistic therapy, we will also ask about your lifestyle factors such as sleeping position, work, exercise and more. We may suggest changes to the positions or activities you are doing to see if it makes an improvement of the symptoms.

Surgically, nerve blocks using a lidocaine solution may be used or a local corticosteroid injection. If there is a build-up of scar tissue in the area the practitioner may work on that or refer you to a specialist for a procedure called neurolysis for nerve decompression – this has been seen to be effective in patients with nerve injured less than or equal to 8 cm in length. There is a healing time of 3-4 months however healing can take up to 12 months depending on a range of factors.

References

Carpal tunnel syndrome: MedlinePlus Genetics. (n.d.). Medlineplus.gov. https://medlineplus.gov/genetics/condition/carpal-tunnel-syndrome/

Fortier, L.M., Markel, M., Thomas, B.G., Sherman, W.F., Thomas, B.H., Kaye, A.D. (2021). An update on

peroneal nerve entrapment and neuropathy. Orthopaedic reviews, 13(2). Pp 24937. https://doi.org/10.52965/001c.24937

Klifto, K.M., Azoury, S.C., Gurno, C.F., Card, E.B., Levin, L.S., Kovach, S.J. (2022). Treatment approach

to isolated common peroneal nerve palsy by mechanism of injury: systemic review and meta-analysis of individual participatnts’ data. Journal of plastic, reconstructive and aesthetic surgery, 75(2). Pp 683-702. https://doi.org/10.1016/j.bjps.2021.09.040

LaPrade, R. (2022). Peroneal Nerve Entrapment.

Peroneal Nerve Entrapment (drrobertlaprademd.com)