Nerve Related Injuries

Nerve related injuries  present a variety of symptoms either in isolation or in conjunction with each other. Some symptoms include  but are not limited to;

• Burning
• Paresthesia
• Numbness
• Electricity
• Itchiness
• Freezing

Upon examination, there may also be signs of;

• Atrophy
• Weakness
• Changes in muscle tone
• Changes in deep tendon reflexes
• Changes in sensation (vision, hearing, smell, taste, touch)
• Changes in cognition and mood

Before making an accurate diagnosis, practitioners need a sound understanding of;

1.  Upper v Lower Motor Neuron Lesions
2.  Centralisation v Peripheralisation
3.  Radiculopathy v Radicular Pain v Radiculitis v Referred Pain v Radiating Pain

Upper Motor Neuron Lesion Signs & Symptoms:

• Muscle weakness
• Hyperreflexia
• Hypertonicity
• Clonus
• The Babinski response

Lower Motor Neuron Lesion Signs & Symptoms:

• Muscle atrophy
• Weakness
• Fasciculation
• Fibrillation
• Hypotonia
• Hyporeflexia

Centralisation v Peripheralisation;

Centralisation implies the referred pain and/or radicular pain moves towards the center of the spine.

Peripheralisation implies the pain moves away from the spine and into the extremity.

Depending on the diagnosis and cause of the referred and/or radicular pain, the severity of pain may increase or decrease in intensity with either situation.

With regards to disc derangement pain, it’s not uncommon for the pain to centralise with a reduction of disc derangement – and distalise with worsening disc derangement.

The opposite is typically seeing with paraesthesia symptoms. The symptom will start distally and centralise as the injury worsens and move distally as the tissue insult is resolved or reduces.

Radiculopathy v Radicular Pain v Radiculitis v Referred Pain v Radiating Pain:

• Radiculopathy is any disease process that affects a spinal nerve root.
• Radicular pain is a symptom of radiculopathy, wherein pain that radiates from the spinal nerve root either part or all the way into the extremity.
• Radiculitis is a specific form of radiculopathy that implies a spinal nerve root is inflamed, rather than compressed or irritated.
• Referred pain implies pain is felt at a location away from the tissue in lesion. For example, the jaw pain felt during a heart attack.
• Radiating pain is associated with impingement and/or compression of a peripheral sensory nerve. The pain follows the path of a peripheral sensory nerve.

The common diagnoses for injuries of the nerves include but are not limited to;

• Carpal tunnel syndrome
• Radial nerve entrapment
• Ulnar nerve entrapment
• Brachial plexus injury
• Thoracic outlet syndrome
• Trigeminal neuralgia
• Intercostal neuralgia
• Lumbar plexus injury
• Sacral plexus injury
• Sciatic nerve entrapment (sciatica)
• Femoral nerve entrapment
• Lateral femoral cutaneous nerve entrapment (meralgia paresthetica)
• Peroneal nerve injury

Depending on the specific diagnosis, management of treatable nerve injuries should focus on addressing the pain and/or dysfunction at the injury/pain site as well as assessing and improving the functionality of the overlying and surrounding tissues and joint structures.

This is achieved via a conservative hands-on approach involving;

• Passive joint mobilisation
• Neural tissue therapy techniques
• Soft tissue therapy
• Targeted adjustments
• Progressive rehabilitation