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Mononeuropathy

By Michael Rubin, MDCM, Professor of Clinical Neurology;Attending Neurologist and Director, Neuromuscular Service and EMG Laboratory, Weill Cornell Medical College;New York Presbyterian Hospital-Cornell Medical Center

Mononeuropathy is damage to a single peripheral nerve.

  • Pressure on a nerve for a long time can damage it.

  • The affected area may tingle, feel prickly, or be numb, and the affected muscle may be weak.

  • Usually, mononeuropathy is diagnosed based on symptoms and results of a physical examination.

  • Modifying or stopping the activity that caused the problem and taking pain relievers usually help, but sometimes corticosteroid injections, physical therapy, or surgery is needed.

Causes of Mononeuropathy

Physical injury is the most common cause of a mononeuropathy. Injury is commonly caused by pressure on a nerve, such as the following:

  • Prolonged pressure on a nerve that runs close to the surface of the body near a prominent bone, such as a nerve in an elbow, a shoulder, a wrist, or a knee (as may occur during a long, sound sleep, especially in alcoholics)

  • Pressure from a misfitting cast or from crutches that fit poorly or that are used incorrectly

  • Pressure from staying in a cramped position for a long time, as when gardening or when playing cards with the elbows resting on a table

Pressure may also injure nerves when people cannot move for long periods, as when they are under anesthesia for surgery, are confined to bed (particularly older people), are paralyzed, or have lost consciousness.

Less commonly, nerve injury results from the following:

  • Accident

  • Prolonged exposure to cold or heat

  • Radiation therapy for cancer

  • Repeated injuries, such as those due to tight gripping of small tools or to excessive vibration from an air hammer

  • Infections, such as leprosy or Lyme disease

  • A pocket of blood (hematoma)

  • Cancer, which may directly invade a nerve

If the pressure on the nerve is mild, people may feel only pins-and-needles sensations without any weakness. For example, people may hit their elbow (funny bone), or a foot may fall asleep. These episodes can be considered temporary mononeuropathies.

Nerves that run close to the body’s surface near a bone are more vulnerable to injury. For example, the following nerves may be damaged:

Did You Know...

  • Using crutches that are the wrong height can damage a nerve in the armpit and make the hand and wrist weak.

Symptoms of Mononeuropathy

Abnormal sensations, including pins-and-needles or loss of sensation, occur in the area supplied by the injured nerve. Pain and weakness may or may not be present. Occasionally, weakness results in paralysis, which can lead to permanent shortening of muscles (contractures).

Carpal tunnel syndrome

The median nerve passes through a narrow passageway at the wrist.

Pressure on this nerve causes pain and abnormal sensations (such as numbness, tingling, or burning) in the following:.

  • Some fingers (the thumb, the second and third fingers, and thumb side of the fourth finger)

  • The palm side of the hand and wrist

  • Sometimes the arm

Chronic carpal tunnel syndrome can cause muscles in the hand on the thumb side to weaken and waste away (atrophy).

Peroneal nerve palsy

The peroneal nerve passes close to the surface of the skin just below the knee, on the outer side of the leg. Pressure on this nerve results in peroneal nerve palsy.

Peroneal nerve palsy weakens the muscles that lift the foot, so that people cannot flex their ankle to lift the front part of their foot (a condition called footdrop). As a result, they may drag the front part of the foot along the ground as they walk.

Peroneal nerve palsy is most common among thin people who are confined to bed, people who are incorrectly strapped into a wheelchair, and people (especially thin people) who habitually cross their legs for long periods of time.

Avoiding pressure on the nerve—for example, by not crossing the legs—usually relieves the symptoms.

Radial nerve palsy

The radial nerve passes along the underside of the bone in the upper arm. Prolonged pressure on this nerve results in radial nerve palsy. This disorder is sometimes called Saturday night palsy because it occurs in people who drink heavily (often during weekends) and then sleep soundly with an arm resting against a bar counter, draped over the back of a chair, or under their partner’s head. If crutches fit incorrectly and press on the inside of the arm near the armpit, they can cause this disorder.

The nerve damage weakens the wrist and fingers so that the wrist may flop into a bent position with the fingers curved (a condition called wristdrop). Occasionally, the back of the hand may lose feeling.

Usually, radial nerve palsy resolves once the pressure is relieved.

Ulnar nerve palsy

The ulnar nerve passes close to the surface of the skin at the elbow. The nerve is easily damaged by repeatedly leaning on the elbow or by hitting the elbow (funny bone). Sometimes the nerve is damaged by an abnormal bone growth in the area. Compression of the ulnar nerve at the elbow is called cubital tunnel syndrome.

Usually, people feel a tingling, pins-and-needles sensation in the little and ring fingers. Ulnar nerve palsy that results from more severe injury makes the muscles in the hand weak. Severe, chronic ulnar nerve palsy can cause muscles to waste away (atrophy), resulting in a clawhand deformity (the fingers are frozen in a bent position because the muscles become tight).

Avoiding pressure on the elbow is recommended.

Diagnosis of Mononeuropathy

  • A doctor's evaluation

  • Sometimes electromyography and nerve conduction studies

Usually, doctors can diagnose mononeuropathies based on symptoms and results of a physical examination.

  • Rule out other possible causes

  • Determine where the nerve is damaged

  • Determine how severe the disorder is

Treatment of Mononeuropathy

  • Treatment of the cause

  • If pressure is temporary, rest, removal of pressure, and nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Sometimes corticosteroid injections, a splint, surgery, and/or physical therapy

If the cause is a disorder, it is treated. For example, a tumor may be surgically removed.

Usually, when temporary pressure is the cause, the following can help relieve symptoms:

  • Resting

  • Not putting pressure on the nerve

  • Placing heat on the affected area

  • Taking NSAIDs, such as ibuprofen, to reduce inflammation

Some people with carpal tunnel syndrome benefit from corticosteroid injections.

Braces or splints are often used to prevent contractures until the symptoms resolve.

Surgery may be done to relieve pressure on a nerve if the disorder progresses despite other treatments. In such cases, surgery for carpal tunnel syndrome is usually effective.

For severe, chronic ulnar nerve palsy, physical therapy helps prevent tightening of muscles.

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