関: entrapment neuropathy、nerve compression syndrome

WordNet

any bundle of nerve fibers running to various organs and tissues of the body (同)nervus
a defense that claims the defendant would not have broken the law if not tricked into doing it by law enforcement officials
control of your emotions; "this kind of tension is not good for my nerves"

PrepTutorEJDIC

〈C〉『神経』 / 〈C〉《複数形で》『神経過敏』,いらだち / 〈U〉『勇気』,度胸(courage) / 〈U〉《時にa ~》厚かましさ,ずぶとさ;無礼 / 〈C〉葉脈;(昆虫の)翅脈(しみゃく) / 〈人,特に自分〉‘に'力を与える,‘を'元気づける
わなにかけること,陥れること

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/03/18 15:00:32」(JST)

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"Trapped nerve" redirects here. For other uses, see Trapped nerve (disambiguation).

Nerve compression syndrome or compression neuropathy, also known as entrapment neuropathy, is a medical condition caused by direct pressure on a single nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression (by a herniated disc, for example). Its symptoms include pain, tingling, numbness, and muscle weakness. The symptoms affect just one particular part of the body, depending which nerve is affected. Nerve conduction studies help to confirm the diagnosis. In some cases, surgery may help to relieve the pressure on the nerve, but this does not always relieve all the symptoms.

Nerve injury by a single episode of physical trauma is in one sense a compression neuropathy, but is not usually included under this heading.

Pathophysiology

External pressure reduces flow in the vessels supplying the nerve with blood (the vasa nervorum). This causes local ischaemia, which has an immediate effect on the ability of the nerve axons to transmit action potentials. As the compression becomes more severe over time, focal demyelination occurs, followed by axonal damage, and finally scarring.

Causes

A nerve may be compressed by prolonged or repeated external force, such as sitting with one's arm over the back of a chair (radial nerve), frequently resting one's elbows on a table (ulnar nerve), or an ill-fitting cast or brace on the leg (peroneal nerve).

Part of the patient's own body can cause the compression, and the term entrapment neuropathy is used particularly in this situation. The offending structure may be a well-defined lesion such as a tumour (for example a lipoma, neurofibroma or metastasis), a ganglion cyst or a haematoma. Alternatively, there may be expansion of the tissues around a nerve in a space where there is little room for this to occur, as is often the case in carpal tunnel syndrome. This may be due to weight gain or peripheral oedema (especially in pregnancy), or to a specific condition such as acromegaly, hypothyroidism or scleroderma.

Some conditions cause nerves to be particularly susceptible to compression. These include diabetes, in which the blood supply to the nerves is already compromised, rendering the nerve more sensitive to minor degrees of compression. The genetic condition HNPP is a much rarer cause.

The causes of each particular syndrome are discussed on the relevant pages, listed below.

Diagnosis

The symptoms and signs depend on which nerve is affected, where along its length the nerve is affected, and how severely the nerve is affected. Positive sensory symptoms are usually the earliest to occur, particularly tingling and neuropathic pain, followed or accompanied by reduced sensation or complete numbness. Muscle weakness is usually noticed later, and is often associated with muscle atrophy.

A compression neuropathy can usually be diagnosed confidently on the basis of the symptoms and signs alone. However, nerve conduction studies are helpful in confirming the diagnosis, quantifying the severity, and ruling out involvement of other nerves (suggesting a mononeuritis multiplex or polyneuropathy). A scan is not usually necessary, but may be helpful if a tumour or other local compressive lesion is suspected.

Nerve injury, as a mononeuropathy, may cause similar symptoms to compression neuropathy. This may occasionally cause diagnostic confusion, particularly if the patient does not remember the injury and there are no obvious physical signs to suggest it.

The symptoms and signs of each particular syndrome are discussed on the relevant pages, listed below.

Treatment

When an underlying medical condition is causing the neuropathy, treatment should first be directed at this condition. For example, if weight gain is the underlying cause, then a weight loss programme is the most appropriate treatment. Compression neuropathy occurring in pregnancy often resolves after delivery, so no specific treatment is usually required.

Some compression neuropathies are amenable to surgery: carpal tunnel syndrome and cubital tunnel syndrome are two common examples. Whether or not it is appropriate to offer surgery in any particular case depends on the severity of the symptoms, the risks of the proposed operation, and the prognosis if untreated. After surgery, the symptoms may resolve completely, but if the compression was sufficiently severe or prolonged then the nerve may not recover fully and some symptoms may persist.

Drug treatment may be useful for an underlying condition (including peripheral oedema), or for ameliorating neuropathic pain.

List of syndromes

Upper limb

nerve	place	usually referred to as
median	carpal tunnel	carpal tunnel syndrome
median (anterior interosseous)	proximal forearm	anterior interosseous syndrome
median	pronator teres	pronator teres syndrome
median	ligament of Struthers	ligament of Struthers syndrome
ulnar	cubital tunnel	cubital tunnel syndrome
ulnar	Guyon's canal	Guyon's canal syndrome
radial	axilla	radial nerve compression
radial	spiral groove	radial nerve compression
radial (posterior interosseous)	proximal forearm	posterior interosseous nerve entrapment
radial (superficial radial)	distal forearm	Wartenberg's Syndrome
suprascapular	suprascapular notch	suprascapular nerve entrapment

Lower limb, abdomen and pelvis

nerve	place	usually referred to as
common peroneal	fibular neck	peroneal nerve compression
tibial	tarsal tunnel	tarsal tunnel syndrome
lateral cutaneous nerve of thigh	inguinal ligament	meralgia paraesthetica
sciatic	piriformis	piriformis syndrome [not always due to entrapment]
iliohypogastric	lower abdomen	iliohypogastric nerve entrapment
obturator	obturator canal	obturator nerve entrapment
pudendal	pelvis	pudendal nerve entrapment
abdominal cutaneous nerves	abdominal wall	abdominal cutaneous nerve entrapment syndrome

UpToDate Contents

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1. 下肢末梢神経症候群の概要 overview of lower extremity peripheral nerve syndromes
2. 上肢末梢神経症候群の概要 overview of upper extremity peripheral nerve syndromes
3. 慢性腹壁痛 chronic abdominal wall pain
4. 知覚異常性大腿神経痛（外側大腿皮神経絞扼） meralgia paresthetica lateral femoral cutaneous nerve entrapment
5. 骨盤手術に関連する神経損傷 nerve injury associated with pelvic surgery

English Journal

A novel variant of the cleidocervicalis muscle with clinical implications for nerve compression/entrapment.

Billings HJ1, Sherrill WC 3rd.
Surgical and radiologic anatomy : SRA.Surg Radiol Anat.2015 Aug;37(6):697-9. doi: 10.1007/s00276-014-1384-5. Epub 2014 Oct 19.
PURPOSE: The cleidocervicalis muscle occurs in approximately 1-3 % of the population that may be confused with pathological neck masses. We describe a novel variant of the muscle and its clinical implications.METHODS: This is a case report of a cleidocervicalis muscle variant identified during rout
PMID 25326903

Ultrasound-Guided Perineural Injection at Guyon's Tunnel: An Anatomic Feasibility Study.

Meng S1, Tinhofer I2, Grisold W3, Weninger WJ2.
Ultrasound in medicine & biology.Ultrasound Med Biol.2015 Aug;41(8):2119-24. doi: 10.1016/j.ultrasmedbio.2015.03.032. Epub 2015 May 1.
Compression of the ulnar nerve (UN) at the wrist causes neuropathy in the ulnar tunnel (UT), or Guyon's tunnel. In the absence of trauma and motor syndromes, primarily conservative treatment is considered. As in carpal tunnel syndrome, a perineural injection of corticosteroids may be beneficial. The
PMID 25937521

Functional outcomes and complications after surgical repair of triceps tendon rupture.

Kose O1, Kilicaslan OF, Guler F, Acar B, Yuksel HY.
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie.Eur J Orthop Surg Traumatol.2015 Jul 12. [Epub ahead of print]
OBJECTIVE: The purpose of this study was to present the functional outcomes and complications after primary repair of triceps tendon ruptures (TTR).PATIENTS AND METHODS: A retrospective review was performed on eight patients (six males, two females) who underwent transosseous suture repair for TTR.
PMID 26164405

Japanese Journal

糖尿病と整形外科的神経疾患 (特集糖尿病の神経学revisited)

夏目唯弘,平田仁
Brain and nerve
NAID 40019972807

腰椎後方除圧術:—よりよい手術成績を得るためのわれわれの工夫—

金景成,井須豊彦,國保倫子,森本大二郎,岩本直高,千葉泰弘,菅原淳,小林士郎,森田明夫
Japanese Journal of Neurosurgery 23(6), 468-475, 2014
腰部脊柱管狭窄症は罹病率の高い疾患であり, 時に外科治療が優れた治療効果を発揮することから, 安易に外科治療が行われてしまうこともあるが, 自然経過を十分理解したうえで保存療法を基本とし, 手術は低侵襲に行うべきである. 外科治療は後方支持組織を可能なかぎり温存し, 適切に神経根を除圧することを目的とすべきで, 決して脊柱管の除圧のみで満足すべきではない. 一方固定術は, 明確なエビデンスのない …
NAID 130004610381

頭蓋表層の解剖学的要因による頭皮神経痛と頭痛―眼窩上神経痛・後頭神経痛・開頭術後頭痛―

清水曉
臨床神経学 54(5), 387-394, 2014
眼窩上神経痛と後頭神経痛は代表的な頭皮神経痛である．従来，特発性とされたこれらの頭皮神経痛の中に，頭皮感覚神経への頭蓋表層構造の機械的刺激によるものがあることが近年明らかにされている．眼窩上神経痛は表情筋による眼窩上神経の絞扼が，後頭神経痛は後頸部筋群による後頭神経群の絞扼（主に頭半棘筋による大後頭神経の絞扼）および後頭動脈と大後頭神経の接触が原因となりえる．近年，これらの解剖学的原因への外科的減 …
NAID 130004505576