#mononeuropathy

[disability-shout-outs]

Shout out to folks with Mononeuropathy/Focal Neuropathy!

[dissociacrip]

wtf makes it so nerves get so easily irritated? crossing my legs for even a few minutes can irritate my sciatic nerve in my left leg even if just for a few minutes & then it seems to be bilateral with the ulnar nerves in my arms when i have them bent or pressed on for even a few minutes, i'm mostly assuming i'm just built poorly why are these bitches so finicky

[drawittoknowitmedical]

NEUROPATHY

Affects ~ 20 million people in the US.

Classifications

Most common cause in the US is diabetic polyneuropathy (distal, symmetric, "dying-back neuropathy")

Polyneuropathy (if many nerves affected)

Mononeuropathy (single, isolated nerves)

Radiculopathy (nerve roots)

PHYSICAL EXAM FINDINGS

Muscle Stretch Reflexes

Absent/Reduced

In distal, symmetric polyneuropathy (most common form), ankle reflexes will be the first to be lost.

Sensation

Absent/Reduced

In distal, symmetric polyneuropathy (most common form), "there is a stocking-glove distribution pattern of sensory loss" with sensation being lost in toes, first.

Motor

Variable

In distal, symmetric polyneuropathy (most common form), since this is a "dying-back neuropathy", most common pattern of weakness is wasting/weakness at the ends of limbs (distally) that slowly works its way proximally: manifests first with changes in the feet and can lead to "neuropathic foot".

Prolonged, chronic neuropathy will lead to disuse atrophy.

Gait

Wide-based, unsteady

ETIOLOGIES

Physical injury

Metabolic and endocrine disorders

Vasculopathy

Autoimmune disease (chronic)

Autoimmune disease (acute)

Renal disease

Cancer

Neuromas

Viruses

Bacteria

Tick-borne infection

Toxins

Trauma

Repetitive injury (eg, carpal tunnel syndrome: mononeuropathy of median nerve, distally)

Diabetes mellitus

Hypothyroidism

Hepatopathy (liver disease)

Growth hormone abnormalities (ie, acromegaly)

Vasculitis

Small vessel ischemia from diabetes

Sjogren’s syndrome

Systemic lupus erythematosus

Rheumatoid arthritis

Guillain-Barré syndrome (acute inflammatory demyelinating polyneuropathy (AIDP))

AIDP with progression to CIDP

Lymphoma

Paraneoplastic-related neuropathy

Chemotherapies

Herpes varicella zoster (shingles)

Human immunodeficiency virus (HIV)

Epstein-Barr virus

West Nile virus

Cytomegalovirus

Lyme disease

Diphtheria

Leprosy (key world-wide cause of neuropathy)

Virus or Bacteria

Medications (eg, certain chemotherapies, amiodarone, dapsone, thalidomide, INH, nitrofurantoin, hydralazine, etc...)

Environmental/Industrial (lead, mercury, and arsenic, insecticides, solvents)

Alcohol (chronic, heavy)

Recommended References:

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet

https://www.foundationforpn.org/wp-content/uploads/2016/10/Medications-that-Can-Cause-Peripheral-Neuropathy.pdf

[dissociacrip]

cubital tunnel syndrome just seems unnecessary