On Dec 3 "Pat" posed a question about his/her case of Ulner Nerve entrapment plus full body (small fiber) sensory neuropathy. I think I may have essentially the same thing, except that I have bilateral peroneal palsies, minor conduction slowing at the elbow (and I am not a leg crosser, etc.) plus clinicalsymptoms of full body sensory neuropathy (predominantly small fiber). The painful burnings, disturbing weakness, and lack of answers have driven me to try to struggle through neurology literature and I have been picking my way through your very difficult field with growing admiration for those of you who devote your lives to trying to help all of us with such disdresing and puzzling symptoms. In any event, I recently found the following: "The statement has been made that patients with diffuse neuropathies show increased susceptibility to compression injury...[A]n individual with a diffuse neuropathy and consequently a reduced complement of nerve fibers is less able to afford loss of fibers from superimposed entrapment or compression injury...It is general clinical experience that patients with diabetes are more liable to develop compression and entrapment neuropathies, but community-based surveys are lacking. Focal nerve injury caused by external compression or entrapment is related both to axoplasmic displacement and secondary myelin damage. Increased vulnerability in diabetes could possibly result from reduced complicance of the Schwann cell basal laminal ensheathment with is abnormally rigid in diabetes" (Asbury & Thomas, Periphereral Nerve Disorders 2, 1995, p. 22). The last two sentences are incomprehensible to me, but I would be most intersted to know if CCF neurologists have any hypotheses--in light of the above--regarding small fiber neuropathies & compression/entrapment.
Thank you very much.
It is generally accepted that focal compressive neuropathies or entrapments, specially carpal tunnel syndrome and ulnar neuropathy at the elbow, are far more frequently seen in individuals with diabetic neuropathy than in an equivalent set of individuals without diabetes. The cause of this is not quite known. The last two sentences from your quote from a very authoritative source presents hypotheses (opinions) based upon some experimental data.
Such an observation has not been made with generalized neuropathy from other causes. Peroneal, radial, and ulnar neuropathies may be more common with alcoholic peripheral neuropathy, but these have other explanations (loss of weight, habit, etc.). Amyloidosis causes carpal tunnel syndrome in addition to causing a generalized small fiber neuropathy, but this is attributed to nerve thickening. But in general, there is no convincing evidence to show that focal neuropathies are more liable to occur in the presence of a generalized neuropathy other than diabetes.
Two other conditions that come to mind in this scenario are:
1) Hereditary neuropathy with pressure palsies (HNPP) which runs in familes, and is associated with events of focal nerve palsies (peroneal, radial, median, ulnar), and the subsequent development of a generalized neuropathy. EMG (demyelination) and genetic tests diagnose this condition.
2) Vasculitic mononeuritis multiplex. Individual mononeuropathies may summate to what appears to be a generalized neuropathy with some focal features.
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