Ask a Vail Sports Doc column: Spontaneous nerve pain still misunderstood, treatments improving
Ask a Vail Sports Doc
It’s hard to imagine suddenly losing sensation or muscle function or having extreme nerve pain occur without reason. Unfortunately, some nerve injuries or nerve abnormalities can happen without warning.
Nerve palsies are rare but can be debilitating. Generally, nerves are injured due to a specific incident, such as a fracture or dislocation. However, nerve palsies can occur spontaneously and the cause is unknown at times. Nerves commonly affected by a spontaneous nerve palsy are the peroneal nerve, brachial plexus, suprascapular nerve, and lateral femoral cutaneous nerve.
Peroneal nerve palsy, or common peroneal nerve entrapment, is the most common spontaneous nerve palsy of the lower limb. The common peroneal nerve travels around the neck (upper end) of the fibula (small outer lower leg bone), where it is very vulnerable to injury. The nerve can be stretched or cut with an injury to the lower leg.
The nerve supplies the muscles that raise your foot and toes as well as providing sensation to the top of your foot. This nerve can become entrapped without any antecedent trauma resulting in weakness to the muscles that raise the foot and toes and numbness on the top of the foot. The reason for developing entrapment is usually unknown.
With palpation of the common peroneal nerve, patients often have a “zing” type sensation down the outer aspect of the lower leg onto the top of the foot. Treatment of peroneal nerve palsy can range from conservative treatment of rest and observation to surgical intervention. Surgery usually involves decompressing the nerve. As long as the nerve has not been entrapped for months and months which can cause irreversible damage, the surgically decompressing the nerve is typically successful in solving the problem.
OTHER NERVE PALSIES
Another spontaneous nerve palsy is Parsonage-Turner Syndrome This syndrome can affect any nerve within the brachial plexus, a network of nerves that supplies nerve fibers to the upper extremity and shoulder.
It is a rare syndrome that usually affects only one shoulder, is very abrupt in its nature, and increases quickly with severity of pain. The syndrome is self-limiting, with pain lasting around two weeks with weakness lasting for approximately a month.
Another nerve palsy affecting the shoulder is suprascapular nerve palsy. This nerve provides function to the supraspinatus and infraspinatus muscles, which comprise half of the rotator cuff musculature. Palsy to this nerve will not only cause pain but can affect the strength of these muscles. Treatment consists mainly of rest, observation, and pain control unless there is something compressing the nerve.
Lateral femoral cutaneous nerve palsy, also known as Meralgia Paresthetica, affects sensation along the outer aspect of the thigh. Pain is usually the most common complaint with this type of nerve palsy. It can be caused by mechanical compressions from obesity, tight clothing, muscle spasms as well as from metabolic issues such as diabetes and alcoholism. Patients complain of burning, numbness, muscle aching, or a “buzzing” within the nerve region. There are both non-surgical and surgical treatments for lateral femoral cutaneous nerve palsy.
Spontaneous nerves palsies as a whole are still somewhat misunderstood. Pain and loss of function continue to be the mainstay of symptoms. Fortunately, treatment options are continuing to improve.
Gretchen Meador is a physician assistant with Dr. Richard Cunningham, of Vail-Summit Orthopaedics. Cunningham is a board-certified, fellowship-trained orthopedic surgeon and knee and shoulder specialist with Vail-Summit Orthopaedics. For more information, visit www.vailknee.com.