Mononeuropathies are usually caused by trauma, compression, or entrapment. Sensory and motor symptoms are in the distribution of a single nervemost commonly the ulnar or median nerve in the arm or peroneal (fibular) nerve in the leg. Intrinsic factors making pts more susceptible to entrapment include arthritis, fluid retention (pregnancy), amyloid, hypothyroidism, tumors, and diabetes mellitus. Clinical features favoring conservative management of median neuropathy at the wrist (carpal tunnel syndrome) or ulnar neuropathy at the elbow include sudden onset, no motor deficit, few or no sensory findings (pain or paresthesias may be present), and no evidence of axonal loss by EMG. Surgical decompression is considered for chronic mononeuropathies that are unresponsive to conservative treatment if the site of entrapment is clearly defined. The most common mononeuropathies are summarized in Table 193-3.
For a more detailed discussion, see Amato AA, Barohn RJ: Peripheral Neuropathy, Chap. 459, p. 2674; and Hauser SL, Amato AA: Guillain-Barré Syndrome and Other Immune-Mediated Neuropathies, Chap. 460, p. 2694, in HPIM-19. |