Neuropathy Presentation II:�El Paso, TX. Chiropractor, Dr. Alexander Jimenez�continues the overview with neuropathy part II. Continued are the most common neuropathies to be seen in practice. Because the human body is composed of many different kinds of nerves which perform different functions, nerve damage is classified into several types. Neuropathy can also be classified according to the location of the nerves being affected and according to the disease causing it. For instance, neuropathy caused by diabetes is called diabetic neuropathy. Furthermore, depending on which nerves are affected will depend on the symptoms that will manifest. The complications which follow neuropathy depends on the type of nerves that are damaged. According to Dr. Jimenez, different neuropathies can cause numbness and/or tingling sensations, increased pain or the loss of ability to feel pain, muscle weakness along with twitching and cramps, even dizziness and/or loss of bladder control function.
Contents
Sciatic Nerve Entrapment
Piriformis Syndrome
Peroneal Nerve Entrapment
Tarsal Tunnel Syndrome
Sciatic N. Piriformis Syndrome
Causes
Anatomic variation
Piriformis overuse/tension
Exam
Positive Lase?gue test possible
Doctor extends patient�s leg passively, while patient is lying supine positive test if maneuver is limited by pain
Tenderness and palpable tension in piriformis muscle which elicits symptoms
Sciatic N. Peroneal Nerve Entrapment
Peroneal or Fibular branch of Sciatic nerve entrapped at the fibular head
Tinel�s sign may be present at fibular head/neck
Usually affects common peroneal nerve, therefore motor and sensory symptoms can be seen
Weakness of ankle dorsiflexion and eversion (tibialis anterior m.)
Sensory disruption on the dorsum of the foot and lateral aspect of the calf
Sciatic N. Tarsal Tunnel Syndrome
Tibial nerve impinged in the tarsal tunnel
Sensory changes in the sole of the foot
Tinel�s sign may be present with percussion posterior to the medial malleolus
Radiculopathy
A mononeuropathy � located in one specific area
Neuropathy involving spinal nerve roots
Presents as changes in sensory and/or motor function affecting a single or a few nerve root level(s)
Nerve sheath tumors (schwannomas and neurofibromas)
Guillain-Barre? syndrome
Herpes Zoster (shingles)
Lyme disease
Cytomegalovirus
Myxedema/Thyroid disorder
Idiopathic neuritis
Narrowing Down Common Causes Of Radiculopathy
Disc Herniation
Most commonly affected nerve roots are C6, C7, L5 & S1
Spinal Stenosis
Lumbar stenosis may produce neurogenic claudication
Pain & weakness with ambulation
Cervical stenosis may present with mixed picture of radiculopathy and myelopathy due to long tract involvement
Trauma
May cause compression, trauma or avulsion of the nerve roots
Diabetes
More likely to cause a polyneuropathy, but mononeuropathy is possible
Herpes Zoster (Shingles)
Most often on the trunk, accompanied by vesicular lesions in a single dermatome
If pain persits past vesicular regression = post-herpetic neuralgia
Patient History Of Radiculopathy
The patient will often complain of burning pain or tingling that radiates or shoots down an affected area in a dermatomal pattern.
Sometimes patient will complain of motor weakness, however if onset is recent, there is often no motor involvement
Exam Of Radiculopathy
Most often hypoesthesia in the affected dermatome level
Best to evaluate for pain, as light touch can be difficult for these patient�s to distinguish
Fasciculations and/or atrophy may be seen if radiculopathy is chronic, due to lower motor neuron being impinged
Motor weakness may be seen in muscles innervated by the same root level
Orthopedic tests:
Straight-leg raise test (SLR)
Pain between 10-60 degrees likely indicates nerve root compression
Well-leg raise/Crossed straight-leg raise test (WLR)
If positive, 90% specificity for L/S nerve root compression
Valsalva Maneuver
Positive if increase in radicular symptoms
Spinal Percussion
Pain may indicate metastatic disease, abscess or osteomyelitis
Examinations: Merck Manual Professional
How To Test Reflexes
How To Do A Sensory Exam
How To Do A Motor Examination
Dermatomes
Testing Cervical Nerve Roots
Testing Lumbosacral Nerve Roots
Specific Radiculopathy Patterns
T1 radiculopathy can cause Horner�s syndrome
This is due to affect on cervical sympathetic ganglia
Ptosis, miosis, anhidrosis
Below L1, radiculopathies can cause Cauda Equina syndrome
Saddle anesthesia (sensory loss in S2-S5 distribution)
Urinary retention or overflow incontinence
Constipation, decreased rectal tone or fecal incontinence
Loss of erectile function
Must be referred for emergency care immediately to prevent permanent dysfunction
Other Patterns Of Neuropathy
Cape/Shawl distribution of symptoms
Intramedullary lesion
Syringomyelia
Intramedullary tumor
Central cord damage
Stocking and Glove Distribution of Symptoms
Diabetes mellitus
B12 deficiency
Alcoholism/hepatitis
HIV
Thyroid dysfunction/myxedema
Cape/Shawl Pattern
Intramedullary lesion such as tumor, syringomyelia or hyperextension injury in patient with C/S spondylosis
Loss of pain and temp sensation in C/T dermatomes because of arrangement of lateral spinothalamic tract
Stocking & Glove Pattern
Symmetrical polyneuropathy
Feet/legs usually affected first, followed by hands/arms
Vibration sensation in the smallest toes is usually the first thing lost and neuropathy progresses across foot to great toe and then upward through the ankle and leg, then hands, arms and finally trunk if sever
Most likely cause of this distribution is diabetes mellitus, but other possible causes include B12 deficiency, alcoholism, HIV, chemotherapy treatment, thyroid dysfunction and multiple other causes
Diabetic Neuropathy
Diabetic neuropathy often presents as a polyneuropathy but can also present as a mononeuropathy, usually with acute onset
Neuropathy Presentation: El Paso, TX. Chiropractor, Dr. Alexander Jimenez�presents an overview of neuropathy. These are the most common neuropathies to be seen in practice.�Neuropathy is a medical term used to characterize damage or injury to the nerves, which refers to the peripheral nerves as opposed to the central nervous system. The complications which follow neuropathy depends largely on the type of nerves that are affected. According to Dr. Alex Jimenez, different neuropathies can cause numbness and tingling sensations, increased pain or the loss of ability to feel pain, muscle weakness along with twitching and cramps, even dizziness and/or loss of control over bladder function.
Contents
Neuropathy
Three primary classifications based on location of symptoms:
If sensory disruption is limited to certain modalities, it implies CNS is involved
If all sensation is affected in the area, implies PNS is involved
Determine Pattern Of Symptoms
Mononeuropathy (focal)?
Mononeuropathy multiplex (multifocal)?
Polyneuropathy (generalized)?
Motor Exam
Determine if there is change to muscle strength
Determine if there is a change in muscle tone
Determine which muscles are affected
Determine if there has been a change in reflexes
This information can help determine the level(s) of involvement
Check For Autonomic�Signs
Auscultate heart
Palpate palms
Auscultate abdomen
Assess autonomic history
For example, is patient complaining about sweating more on one side than another? Complaining of stress levels?
Suggest ANS involvement
Exams: Merck Manual Professional Version
How To Test Reflexes
How To Do The Sensory Exam
How To Do The Motor Examination
Classification Of Nerve Injuries Resulting In Neuropathy
Neurapraxia – This is a transient episode of motor paralysis with little or no sensory or autonomic dysfunction; no disruption of the nerve or its sheath occurs; with removal of the compressing force, recovery should be complete
Axonotmesis – This is a more severe nerve injury, in which the axon is disrupted but the Schwann sheath is maintained; motor, sensory, and autonomic paralysis results; recovery can occur if the compressing force is removed in a timely fashion and if the axon regenerates
Neurotmesis – This is the most serious injury, in which both the nerve and its sheath are disrupted; although recovery may occur, it is always incomplete, secondary to loss of nerve continuity
Brachial Plexopathies
Erb�s Palsy
Klumke�s Palsy
Erb�s Palsy
AKA Erb�Duchenne palsy or Waiter’s tip palsy
Most common mechanism of injury in adults is a patient who fall forward while holding onto something behind them
Can also happen to an infant during childbirth ? Results from damage to C5-6 nerve roots in the brachial plexus
Dermatomal distribution of sensory disruption
Weakness or paralysis in deltoid, biceps, and brachialis muscles resulting in �waiter�s tip� position
Klumke�s Palsy
AKA Dejerine�Klumpke palsy
Happens to infants during childbirth if arm is pulled overhead
Can also happen to adults with overhead traction injuries
Results from damage to C8-T1 nerve roots in the brachial plexus
Dermatomal distribution of sensory disruption
Weakness or paralysis in wrist flexors and pronators as well as muscles of the hand
May produce Horner�s syndrome due to T1 involvement
Results in a �claw hand� appearance
Forearm supinated with wrist hyperextended, with finger flexion
Neuropathy is a medical term used to describe a collection of general diseases or malfunctions which affect the nerves. The causes of neuropathy, or nerve damage, can vary greatly among each individual and these may be caused by a number of different diseases, injuries, infections and even vitamin deficiency states. However, neuropathy can most commonly affect the nerves that control the motor and sensory nerves. Because the human body is composed of many different kinds of nerves which perform different functions, nerve damage is classified into several types. Neuropathy can also be classified according to the location of the nerves being affected and according to the disease causing it. For instance, neuropathy caused by diabetes is called diabetic neuropathy. Furthermore, depending on which nerves are affected will depend on the symptoms that will manifest as a result. Below we will discuss several specific types of neuropathies clinically treated by chiropractors, physical therapists and physical medicine doctors alike, as well as briefly describing their causes and their symptoms.
Contents
Brachial Plexopathies
Brachial plexopathy is a type of peripheral neuropathy, which affects the nerves that transmit messages from the brain and the spinal cord to the rest of the body. This kind of nerve damage occurs when harm affects the brachial plexus, a region found on each side of the neck where nerve roots from the spinal cord branch out into each arm’s nerves. Damage, injury or a condition that impacts these nerve roots can result in pain, decreased mobility and reduced sensation in the arm and shoulder. In some cases, no cause can be identified.
Erb’s Palsy
Erb’s Palsy, also known as�Erb�Duchenne palsy or Waiter’s tip palsy, is identified as a paralysis of the arm caused by damage or injury to the nerves in the neck which form part of the brachial plexus. The most common mechanism of injury in adults with Erb’s Palsy is a patient who fell forward while holding onto something behind them. Erb�Duchenne palsy can also happen to an infant during childbirth, most commonly, but not exclusively, from shoulder dystocia during a difficult birth. To be more precise, this type of brachial plexopathy results from damage to the C5-C6 nerve roots along the brachial plexus in the neck. Symptoms of Erb’s Palsy include dermatomal distribution of sensory disruption followed by weakness or paralysis in the deltoid, biceps, and brachialis muscles, leading to the �waiter�s tip� position associated with this type of neuropathy. While many infants can recover on their own from this type of brachial plexopathy, some may require rehabilitation.
Klumpke’s Palsy
Klumpke’s Palsy, also known as Klumpke’s paralysis or�Dejerine�Klumpke palsy, is a partial palsy in the nerve roots of the brachial plexus located along the cervical spine, or neck. It is named after�Augusta D�jerine-Klumpke, an American-born French medical doctor acknowledged for her work in neuroanatomy. Klumpke’s Palsy is characterized as a form of paralysis involving the muscles of the forearm and hand, which occurs to�infants during childbirth if their arm is pulled overhead.�Dejerine�Klumpke palsy can also occur to adults with overhead traction injuries caused by harm to the C8-T1 nerve roots in the brachial plexus and upper thoracic region of the spine. Symptoms of Klumpke’s paralysis include dermatomal distribution of sensory disruption, weakness or paralysis, in the wrist flexors and pronators as well as in the muscles of the hand. This type of brachial plexopathy may often lead to Horner�s syndrome, a collection of symptoms which manifest when a set of nerves, known as the sympathetic trunk, are damaged or injured due to T1 involvement. This form of neuropathy is identified by resulting�in a �claw hand� appearance, where the forearm is supinated with the wrist hyperextended, together with finger flexion.
Entrapment Neuropathies
Entrapment neuropathy, also known as nerve compression syndrome or compression neuropathy, is best-known as nerve damage or a type of neuropathy caused by direct pressure on a nerve. Common symptoms include pain and discomfort, tingling or burning sensations, numbness and muscle weakness which affects only a particular part of the human body, depending on which nerve is affected. A nerve can become compressed as a result of a constant external force or due to a lesion, such as a tumor. Additionally, some conditions can make the nerves more susceptible to compression, including diabetes, where the nerves are rendered more sensitive to minor degrees of compression due to their already compromised supply of blood. Nerve damage caused by a single episode of harm can be considered an entrapment neuropathy, however, it is generally not classified under this group of compression neuropathy or nerve compression syndrome.
Thoracic Outlet Syndromes
Thoracic outlet syndromes are a group of disorders which develop when the nerves or blood vessels between the collarbone and the thoracic outlet, located in the region of the first rib, are compressed. As a result, this can cause pain and discomfort in the neck and shoulders as well as numbness in the fingers. There are a number of types of thoracic outlet syndromes, including neurogenic, or neurological, thoracic outlet syndrome, specifically caused by the compression of the brachial plexus, vascular thoracic outlet syndrome, which is caused specifically by the compression of the veins, known as venous thoracic outlet syndrome, or arteries, known as arterial thoracic outlet syndrome, and nonspecific-type thoracic outlet syndrome, which is considered to be idiopathic and has been described to worsen with activity. Several healthcare professionals believe that nonspecific-type thoracic outlet syndrome doesn’t exist, while others claim it to be a common disorders. However, the majority of thoracic outlet syndromes are often classified as neurogenic.
Thoracic outlet syndromes are caused by the compression of the cervical rib, an extra “rib” in the seventh cervical vertebra, subclavius muscle tension, improper posture or�excessive thoracic kyphosis, physical trauma, repetitive activity, obesity and pregnancy. Thoracic outlet syndromes can vary depending on which structures are compressed. Thoracic outlet syndromes can be diagnosed using tests, such as the Adsons test, the Allen maneuver, the Costoclavicular maneuver, the Halstead maneuver, the�Reverse bakody maneuver, the Roos test, the Shoulder compression test and the Wright test. Thoracic outlet syndromes can cause permanent neurological damage if not diagnosed and treated early.
Median Nerve Entrapment
Median nerve entrapment or median nerve entrapment syndrome, is a mononeuropathy, a condition that impacts only a single nerve or nerve group outside the brain and spinal cord, which affects the movement of or sensation in the hand. Median nerve entrapment is caused by the compression of the median nerve found in the elbow or distally in the forearm or wrist. Symptoms include sensory disruption in the lateral portion of the palmar aspect of the hand and dorsal finger tips of the same fingers. In addition, motor fibers may also be affected in the forearm, if applicable, including the muscles of the thenar eminence, such as the abductor pollicis brevis, the opponens pollicis, and the flexor pollicis brevis. Other forms of median nerve entrapment syndromes include: pronator teres syndrome and carpal tunnel syndrome.
Pronator teres syndrome is characterized as the compression of the median nerve at the elbow. It is considered rare compared to carpal tunnel syndrome. Pronator teres syndrome is caused by repetitive movement, pronator teres muscle inflammation and thickened bicipital aponeurosis. Clinical findings for this type of neuropathy include, tenderness with palpation of the pronator teres muscle, pain with resisted pronation of the arm, flexor pollicus longus and flexor digitorum profundus involvement, otherwise, symptoms manifestations for pronator teres syndrome may appear similar to carpal tunnel syndrome but without positive wrist orthopedics.
Carpal tunnel syndrome is characterized as the compression of the median nerve at the wrist. Carpal tunnel syndrome is identified by symptoms of pain and discomfort, tingling sensations in the thumb, index finger, middle finger and the thumb side of the ring fingers, and numbness. These can generally start gradually and may extend up the arm. Advanced instances of carpal tunnel syndrome may cause weakened grip strength where the muscles at the base of the thumb may waste away if left untreated for an extended period of time. In many cases, carpal tunnel syndrome may affect both hands or arms. Carpal tunnel syndrome is caused by repetitive movements, hypothyroidism, obesity, rheumatoid arthritis, diabetes and pregnancy. Orthopedic tests utilized to diagnose carpal tunnel syndrome include the use of the Tinel�s Sign, positive if tapping over the median nerve reproduces/exacerbates symptoms, the�Phalen�s Maneuver/Prayer Sign, performed by bringing the hands together, with wrists flexed, and is repeated in reverse with the wrists extended, for at least 60 seconds, and is considered positive if tests reproduce/exacerbate symptoms, and the�Wringing Test, if wringing a towel produces paresthesia.
Ulnar Nerve Entrapment
Ulnar nerve entrapment is a condition where the ulnar nerve itself becomes physically trapped or pinched, resulting in symptoms of pain, numbness and weakness which extends throughout the little finger, the ulnar half of the ring finger and throughout the intrinsic muscles of the hand. Symptoms or ulnar nerve entrapment ultimately involve sensory disruption in the medial two digits of the palmar and dorsal aspects of the hand. Symptoms of ulnar nerve entrapment may vary depending on the specific location of the ulnar nerve compression or impingement. These may also be classified as motor, sensory or both, depending on the location of the injury. If motor fibers are affected in the hand, all fingers, besides the thumb, may become weakened, described as general hand weakness. The most common location of ulnar nerve entrapment is within the cubital tunnel. Other forms of ulnar nerve entrapment include: cubital tunnel syndrome and tunnel of Guyon syndrome.
Cubital tunnel syndrome is identified by the compression or impingement of the ulnar nerve in the cubital tunnel at the elbow. It is considered to be the second most common entrapment neuropathy which affects the upper extremities, following carpal tunnel syndrome. Symptoms of cubital tunnel syndrome are characterized by pain and discomfort along the region of the ulnar nerve entrapment, along with sensory impairment, paresis and paresthesia.�Causes of cubital tunnel syndrome include, repetitive movements, hypothyroidism, obesity, diabetes, physical trauma or injury to the cubital tunnel, and prolonged sitting with pressure on bent elbow.
Tunnel of Guyon syndrome, or Guyon’s canal syndrome, is identified by the compression or impingement of the ulnar nerve at the wrist, particularly along an anatomical space in the wrist known as Guyon’s canal. Guyon’s canal syndrome may also be referred to as ulnar tunnel syndrome. Symptoms of tunnel of Guyon syndrome are similar to those of cubital tunnel syndrome with slight variations depending on the region of ulnar nerve entrapment.�Causes of tunnel of Guyon syndrome include, repetitive movements, long term crutch use, fracture of the hamate, a carpal bone, due to a ganglion cyst, hypothyroidism, obesity, rheumatoid arthritis and diabetes.�Orthopedic tests utilized to diagnose Guyon’s canal syndrome include the use of the�Tinel�s Sign, positive if test over the ulnar nerve at the wrist elicits symptoms, the Wartenberg Sign, positive if the 5th digit abducts when patient performs hard grip strength test or attempts to squeeze fingers together and reduced two-point discrimination in the hand.
Radial Nerve Entrapment
Radial nerve entrapment, also known as radial tunnel syndrome, is a condition caused by the compression of the radial nerve, which travels from the brachial plexus, to the hand and wrist. Healthcare professionals believe that radial tunnel syndrome occurs because the radial nerve becomes irritated or inflamed due to the friction caused by the impingement of the muscles in the forearm. Radial nerve entrapment manifests symptoms of sensory disruption in the lateral three and a half digits of the dorsal aspect of the hand. Motor�fibers may also be affected along the�posterior arm and extensor compartment of the forearm, and wrist drop may be seen. Other forms of radial tunnel syndrome include: spiral groove entrapment, where all radial nerve innervated muscles below entrapment are affected,�Saturday night palsy caused due to sleeping on your own arm and the brachioradialis & triceps reflexes are both diminished, supinator syndrome, caused by the compression at the arcade of Frohse with no change in reflexes. Posterior interosseous syndrome, or radial tunnel syndrome, also elicits no change in reflexes.
Sciatic Nerve Entrapment
Sciatic nerve entrapment is a condition caused by the compression of the sciatic nerve, the longest and largest nerve in the human body, which travels from the low back, down through the buttocks, thighs, legs and into the foot. The collection of symptoms which manifest as a result of sciatic nerve entrapment, including pain and discomfort, tingling and burning sensations, and numbness as well as weakness in the lower extremitites, is commonly known as sciatica. Sciatic nerve entrapment, or sciatica, can be caused by a variety of injuries and/or aggravated conditions which can lead to the compression of the sciatic nerve, including, but not limited to, disc herniation and spinal stenosis. However, symptoms of sciatic nerve entrapment may vary depending on the location of the compression of the sciatic nerve. Other conditions caused by the compression of the sciatic nerve include: piriformis syndrome, peroneal nerve entrapment and tarsal tunnel syndrome.
Piriformis syndrome is a condition which occurs due to the compression of the sciatic nerve as a result of the irritation or inflammation of the piriformis muscle. Symptoms of piriformis syndrome may include pain and discomfort, followed by numbness in the buttocks and down the leg. Symptoms may worsen with regular activities, such as sitting and running. Piriformis syndrome is caused by anatomic variation or due to piriformis overuse/tension. Piriformis syndrome diagnosis exams include, a positive Lase?gue test, where the healthcare professional�extends the patient�s leg passively, while the patient is lying supine,�test is positive if the maneuver is limited by pain, and through the use of tenderness and palpable tension in piriformis muscle which elicits symptoms.
Peroneal nerve entrapment is a condition which occurs when the peroneal or the fibular branch of the sciatic nerve are compressed at the fibular head. Tinel�s sign may be present at the fibular region of the head and/or neck. Peroneal nerve entrapment generally affects the common peroneal nerve, therefore, motor and sensory symptoms may manifest, including, weakness of the ankle dorsiflexion and eversion, or the tibialis anterior. Other symptoms of peroneal nerve entrapment may include sensory disruption on the dorsum of the foot and lateral aspect of the calf. Common peroneal nerve entrapement at the fibular head is the most common nerve entrapment syndrome in the lower extremities.
Tarsal tunnel syndrome, also known as posterior tibial neuralgia, is a condition caused by the compression of the tibial nerve as it travels through the tarsal tunnel, found along the region of the inner leg, posterior to the medial malleolus, or the bump on the inside of the ankle. Tarsal tunnel syndrome can manifest symptoms of pain and discomfort, burning or tingling sensations, and numbness along the big toe and the first three toes. However, symptoms may vary slightly depending on the area of compression, where the entire foot may manifest the symptoms previously described. Other symptoms associated with posterior tibial neuralgia include sensory changes in the sole of the foot. Tinel�s sign may be present with percussion posterior to the medial malleolus. The exact cause of tarsal tunnel syndrome may be difficult to determine and it is essential to receive a proper diagnosis to determine the source of the symptoms.
Radiculopathy
Radiculopathy is a mononeuropathy,�a condition that impacts only a single nerve or nerve group outside the brain and spinal cord, which affects the movement of or sensation in one specific area. It is often associated with neuropathy involving spinal nerve roots and presents as changes in sensory and/or motor function affecting a single or a few nerve root level(s). The most common types of radiculopathies include: sciatica and cervical radiculopathy. The most prevalent causes of radiculopathy include, disc herniation, osteophytes, spinal stenosis, trauma, diabetes, epidural abscess or metastasis, nerve sheath tumors, such as schwannomas and neurofibromas, Guillain-Barre? syndrome, Herpes Zoster, or shingles, Lyme disease, cytomegalovirus, myxedema and/or thyroid disorder, and idiopathic neuritis.
Narrowing down some of the most common causes of radiculopathy, symptoms can manifest due to disc herniation which most commonly affects the nerve roots along the C6, C7, L5 & S1 vertebrae of the spine, spinal stenosis and lumbar stenosis which may produce neurogenic claudication, and pain and weakness with ambulation. Cervical stenosis may present with mixed radiculopathy and myelopathy due to long tract involvement. Symptoms may also manifest due to trauma, because it may lead to compression, trauma or avulsion of the nerve roots, diabetes, which is most�likely to cause a polyneuropathy, but mononeuropathy is possible, and Herpes Zoster, or shingles, most often on the trunk, accompanied by vesicular lesions in a single dermatome. If pain persists past vesicular regression, radiculopathy may instead be considered post-herpetic neuralgia.
Patients with a history of radiculopathy will often complain of burning pain or tingling sensations which radiates or shoots down an affected area in a “dermatomal” pattern. Occasionally, patients will complain of motor weakness, however if onset is recent, there is often no motor involvement. The diagnosis of radiculopathy can depend on a variety of exams.�Most often, hypoesthesia may be present in the affected dermatome level. It’s recommended to�evaluate for pain, as light touch can be difficult for these patient�s to distinguish. Fasciculations and/or atrophy may be seen if radiculopathy is chronic, due to the lower motor neuron being compressed or impinged. Motor weakness may be seen in muscles innervated by the same root level. Orthopedic tests for the diagnosis of radiculopathy may include: the straight-leg raise test (SLR), where pain between 10 to 60 degrees likely indicates nerve root compression, the�Well-leg raise/Crossed straight-leg raise test (WLR), where if positive, 90 percent specificity for L/S nerve root compression may be present, the Valsalva Maneuver, where its considered positive if there is an increase in radicular symptoms, and spinal percussion, where pain may indicate metastatic disease, abscess or osteomyelitis.
Specific radiculopathy patterns may also develop as a result of different regions being affected. Radiculopathy along the T1 can cause Horner�s syndrome, a combination of symptoms caused by the disruption of a nerve pathway from the brain to the face and eye on one side of the body. This is due to its effect on cervical sympathetic ganglia, includind ptosis, miosis, anhidrosis. Radiculopathy below the L1, can cause Cauda Equina syndrome, a condition caused by damage or injury to the bundle of nerves found below the end of the spinal cord, known as the cauda equina. This type of radiculopathy may manifest symptoms of saddle anesthesia, sensory loss in the S2-S5 distribution, urinary retention or overflow incontinence, constipation, decreased rectal tone or fecal incontinence, and loss of erectile function. Individuals with these signs and symptoms must be referred for emergency care immediately to prevent permanent dysfunction.
Other patterns of neuropathy can include the cape/shawl distribution of symptoms, identified by an intramedullary lesion, such as syringomyeli, intramedullary tumor and central cord damage. Stocking and glove distribution of symptoms may manifest as a result of diabetes mellitus,�B12 deficiency, alcoholism and/or hepatitis,�HIV, and thyroid dysfunction and/or myxedema.
The cape/shawl pattern of neuropathy is characterized by symptoms occurring due to an intramedullary lesion, such as a tumor, syringomyelia or a hyperextension injury in patient with C/S spondylosis. It can also be characterized by loss of pain and temperature sensation in C/T dermatomes because of the arrangement of the lateral spinothalamic tract. The stocking and glove pattern may progress gradually depending on its specific stage. It can also be characterized as a symmetrical polyneuropathy, where the feet and legs are generally affected first, followed by the hands and arms. A vibration-like sensation in the smallest toes are also typically the first to go and the neuropathy symptoms may progress across the foot to the big toe and then upward through the ankle and leg, then hands, arms and finally to the trunk if the condition becomes severe. The most likely cause of this pattern may be attributed to diabetes mellitus, but other possible causes include, B12 deficiency, alcoholism, HIV, chemotherapy treatment, thyroid dysfunction and multiple other causes.
Diabetic Neuropathy
Diabetic neuropathy is medically defined as a collection of nerve damaging disorders associated with diabetes. These conditions are believed to occur as a result of a diabetic microvascular injury involving the small blood vessels, known as the vasa nervorum, which supply the nerves. Additionally, macrovascular conditions have also been considered to accumulate and cause diabetic neuropathy.�Diabetic neuropathy often presents as a polyneuropathy, or the simultaneous damage or disease of many peripheral nerves throughout the body, but it can also present as a mononeuropathy, usually with acute onset. Diabetic neuropathy most commonly affects the CN III, femoral and sciatic nerves. Diabetic neuropathy can affect all peripheral nerves, including the sensory neurons, motor neurons and, although rarely, the autonomic nervous system. As a result, diabetic neuropathy can affect all organs and systems, as these are all innervated. Diabetic neuropathy can manifest into a wide array of symptoms, including, but not limited to, pain, burning or tingling sensations, numbness, dizziness and trouble with balance.
Demyelinating Neuropathies
Demyelinating neuropathies can be individually defined by its two types: Acute inflammatory demyelinating polyneuropathy, best known as�Guillain-Barre? syndrome, or Chronic inflammatory demyelinating polyneuropathy.�Guillain-Barre? syndrome, abbreviated as AIDP, is identified as a rapid-onset muscle weakness caused when the immune system damages, harms or destroys the peripheral nervous system. Onset has been reported by around one to two weeks following viral infection with progressive weakness, loss of DTRs/areflexia, paresthesia in the hands and feet, more motor involvement than sensory, potential autonomic fiber involvement, elevated CSF protein, and EMG/NCV studies indicating demyelination.�Guillain-Barre? syndrome may require treatment with plasmapheresis or IV Ig therapy.�Chronic inflammatory demyelinating polyneuropathy, abbreviated as CIDP,�is identified as an acquired immune-mediated inflammatory disorder of the peripheral nervous system which appears similar to AIDP but does not follow infection. Symptoms must be present for at least 8 weeks for this diagnosis to be considered positive.�Anti-inflammatory treatments may help treat CIDP.
The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
The human body needs vitamin D in order to build strong muscles and bones. When the body does not get enough vitamin D, it is not able to absorb calcium effectively. This makes it very important for good bone health. Children who do not get adequate vitamin D develop rickets, a condition that causes weak bones, deformities in the skeleton, and a stooped posture.
Contents
What Is Vitamin D?
Most people believe that vitamin D is a vitamin; it isn�t. It is actually a hormone. A vitamin is a nutrient that the human body requires but is unable to produce. This means that it can only be obtained through supplements and food.
However, the body is able to manufacture this vitamin. When the skin is exposed to the appropriate sunlight, the body begins a process that produces vitamin D. It should also be noted that vitamin D plays a part in a strong immune system and can prevent certain chronic diseases in older adults.
There are supplements for people who do not produce enough vitamin D or who do not get adequate amounts in the food that they eat (fish liver oils, certain fish, and egg yolks are good sources). Children and adults typically do not get enough from their foods and activities. People spend a great deal of time indoors with adults at work and children at school. The emergence of digital devices and video games has managed to keep children inside as they engage in these activities.
This vitamin is not measured in milligrams like many other supplements, but in International Units (IU) instead. Research has caused the daily recommended allowance for vitamin D to increase over the years, and the current recommendation is 400 IU. It has been determined that this amount is the most beneficial in promoting healthy bones.
The Role Of The Skeletal System
The skeletal system has several functions. The first and most obvious is that it is the structural support for the body. It also protects vital organs.
For instance, the skull protects the brain and the rib cage protects the lungs and heart. It is also an anchor point for muscle so it helps with mobility. The red bone marrow provides illness fighting white blood cells, as well as red blood cells. Calcium is stored in the marrow, as is phosphorous. Certain minerals and fats are stored in the yellow marrow which is found in the long bones of the body.
How Vitamin D Benefits The Skeletal System
Getting enough vitamin D helps the body absorb calcium which is a bone building mineral. In addition to that task, it also promotes good muscle health.
Stronger muscles can work much more effectively in protecting the muscles and supporting the skeletal system. This can help with joint health as well. Older people who have adequate vitamin D do not fall down as often and people of all ages have fewer broken bones.
Results Of Vitamin D Deficiency
Vitamin D deficiency is a serious condition mainly due to its essential role in the body�s ability to absorb calcium. Muscle weakness and bone pain are two common symptoms, but are typically seen in more severe cases.
A simple blood test can check for vitamin D levels � and it should be checked regularly. Even �minor� cases of low vitamin (those without any symptoms) have been linked to some serious health conditions including:
Increased risk of death due to cardiovascular disease
Vitamin D is generally very accessible. You can get it through foods and sunlight or via a supplement. People who may have some trouble getting adequate amounts are those who have limited exposure to sunlight, fail to consume the necessary levels of the vitamin, and people who have dark skin. If you think that you may have low vitamin D, it is best to talk to your doctor so you can come up with a plan to get your body back in balance.
A healthcare professional may refer you to a physical therapist to help you relieve your sciatica. Physical therapy includes both passive and active treatments. Passive treatments help unwind you and your body. These ultimately prepare your body for therapeutic exercises, which are the active treatments commonly utilized as a part of physical therapy.
Your physical therapist can give you passive treatments such as:
Deep tissue massage: This procedure targets chronic muscle stress which can be compressing or irritating your sciatic nerve and its associated nerve roots. The physical therapist uses direct friction and pressure to attempt to release the tension in your soft tissues, such as the tendons, ligaments and muscles.
Hot and cold therapies: By employing heat, the physical therapist seeks to get more blood to the target region because an increased blood circulation brings more oxygen and nutrients to the affected area. By way of instance, a heating pack placed on your piriformis muscle may help to reduce muscle spasms that could be causing your sciatica. Cold therapy, on the other hand, slows down blood flow, helping to decrease inflammation, muscle spasms, and pain. Your physical therapist will alternate between hot and cold therapies in order to achieve the desired results.
TENS (transcutaneous electric nerve stimulation): It may even be used at home, if your physical therapist thinks it is necessary. A machine stimulates your muscles through a variety of safe intensities of electric current. TENS helps decrease muscle spasms, and it might increase your body’s production of endorphins, the body’s natural painkillers. The TENS equipment your physical therapist utilizes is larger than the “at-home” usage system. Whether big or small, a TENS device may be an essential treatment for sciatica and its associated symptoms.
Ultrasound: Ultrasound sends sound waves deep in your muscle tissues and makes a gentle heat that enhances circulation and helps to speed up recovery. Greater circulation can help to reduce muscle spasms, cramping, swelling, stiffness, and pain.
In the active part of physical therapy, your physical therapist will teach you various exercises to help treat your sciatica. Your physical therapy’s treatment program is individualized, taking into account your overall health and wellness as well as your medical history. It might consist of strengthening exercises, aerobic conditioning, and movements to increase endurance and range of movement.
Physical therapy might be part of a comprehensive sciatica treatment plan prescribed by your healthcare professional. Aside from receiving physical therapy for your sciatica, or sciatic nerve pain, the following list includes other treatment options which are often considered when discussing the best treatment options for your source of sciatica symptoms. These treatments include:
Alternative treatments, such as acupuncture;
Chiropractic care;
Drugs and/or medications; and
Surgery
If necessary, your physical therapist may teach you how to fix your posture and integrate ergonomic principles into your everyday activities. This will be done in order to work on preventing future episodes of sciatica. Of the list of treatment options to help treat sciatica, chiropractic care and physical therapy are similar to each other and may involve common treatment modalities. However, a chiropractor uses spinal adjustments and manual manipulations to relieve symptoms of sciatica by carefully restoring the original alignment of the spine and reducing spinal stress and tension.
Contents
Dr. Alex Jimenez’s Insight
As its previously been addressed, because sciatica can occur due to a variety of injuries and/or aggravated conditions, a proper diagnosis followed by the best treatment option for the patient’s source of their symptoms is key for overall improvement and prevention of further episodes of sciatic nerve pain. Among the various types of treatment, chiropractic care and physical therapy are popular alternative treatment approaches which help treat sciatica, without the need for drugs and/or medications or surgical interventions. Chiropractic care focuses on correcting the alignment of the spine through the use of spinal adjustments and manual manipulations in order to release tension on the spine and improve sciatic nerve pain.
Chiropractic Care for Sciatica
Chiropractic care is a well-known alternative treatment option which is regularly used to treat sciatica. Proper diagnosis of sciatica Is essential before considering any of the above treatment modalities. Because there are lots of disorders that cause sciatica, the chiropractor’s first step towards treating sciatica would be to determine what’s causing the patient’s relapse. Forming a diagnosis involves a thoughtful review of the patient’s medical history as well as a physical and neurological evaluation.
Diagnostic testing includes x-rays, MRI, CT scans and/or electrodiagnostic tests (nerve conduction speed, electromyography). These examinations and evaluations help to detect potential contraindications to spinal adjustments and manual manipulations along with other chiropractic alternative treatment options. The aim of chiropractic care is to help the human body heal itself. Chiropractic care is noninvasive (non-surgical) and drug-free.
The type of chiropractic care provided depends on the reason for the individual’s sciatica. A sciatica treatment program might include several distinct therapies like ice/cold treatments, ultrasound, TENS, (similar to those used in physical therapy) and spinal adjustments and manual manipulations. Spinal adjustments and manual manipulations differ from a swift high velocity push to those that combine minimal pressure and gentle force. Mastery of every method is an art which requires great precision and skill. Spinal adjustments and manual manipulations are the treatment modalities that differentiate chiropractic care from other medical disciplines.
However, sciatica can be brought on by other disorders beyond the scope of chiropractic care. If the chiropractor determines that the patient’s source of their symptoms requires treatment from a different type of doctor, then the patient is referred to another healthcare professional. In some instances, the chiropractor may continue to treat the patient and also co-manage the patient’s care with another healthcare professional.
The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
El Paso, TX. Chiropractor, Dr. Alexander Jimenez continues the discussion on the anatomy of nerve fibers, receptors, spinal tracts and brain pathway/s. As the spinal nerve nears the spinal cord, it splits into the dorsal and ventral roots. The dorsal root only contains the axons of sensory neurons. While the ventral roots contain only the axons of motor neurons. Some of the branches synapse with local neurons in the dorsal root ganglion, posterior (dorsal) horn, and even the anterior (ventral) horn, at the spine where they enter.
Other branches travel short distances up or down the spine to interact with neurons at other levels of the spinal cord. A branch can also turn into the posterior (dorsal) column white matter to connect with the brain. Spinal nerve systems that connect to the brain are contralateral, in that the right side of the body is connected to the left side of the brain and the left side of the body is connected to the right side of the brain.
Cranial nerves convey specific sense information from the head and neck directly to the brain. Whereas spinal information is contralateral, cranial nerve systems are for the most part�ipsilateral, meaning that a cranial nerve on the right side of the head is connected to the right side of the brain. Some cranial nerves contain only sensory axons. Other cranial nerves have both sensory and motor axons, including the trigeminal, facial and glossopharyngeal. General senses of somatosensation for the face travel through the trigeminal system.
Contents
PATHWAYS
THE POSTERIOR COLUMN� MEDIAL LEMNISCUS SYSTEM CONVEYS INFORMATION ABOUT TOUCH AND LIMB POSITION
POSTERIOR COLUMN MEDIAL LEMNISCAL PATHWAY
The term posterior column refers to the entire contents of a posterior funiculus, exclusive of its share of the propriospinal tract. The posterior columns consist mainly of ascending collaterals of large myelinated primary afferents carrying impulses from various kinds of mechanoreceptors (although substantial numbers of second-order fibers and unmyelinated fibers are also included). This has traditionally been considered the major pathway by which information from low-threshold cutaneous, joint, and muscle receptors reaches the cerebral cortex.
2-Minute Neuroscience: Touch & The Dorsal Columns-Medial Lemniscus
DAMAGE TO THE POSTERIOR COLUMN�MEDIAL LEMNISCUS SYSTEM CAUSES IMPAIRMENT OF PROPRIOCEPTION AND DISCRIMINATIVE TACTILE FUNCTIONS
�As might be expected from the types of afferents contained in the posterior columns, this pathway carries information important for the conscious appreciation of touch, pressure, and vibration and of joint position and movement. However, because input from cutaneous receptors also reaches the cortex by other routes, damage to the posterior columns causes impairment, but not abolition, of tactile perception. Complex discrimination tasks are more severely affected than is the simple detection of stimuli. Other functions, such as proprioception and kinesthesia, are classically considered to be totally lost after posterior column destruction. The result is a distinctive type of ataxia (incoordination of movement); the brain is unable to direct motor activity properly without sensory feedback about the current position of parts of the body. This ataxia is particularly pronounced when the patient�s eyes are closed, preventing visual compensation.�
Given the role of the posterior column, the patient should be screened for any abnormalities regarding their sense of fine touch, vibration, barognosis, graphesthesia, stereognosis, kinaesthesia, two-point discrimination and conscious proprioception:
A common way of testing for fine touch is to ask the patient to recognize common objects placed within a cloth using their touch.
Vibration sense can be tested using a low pitched C128 tuning fork placed along a bony prominence of the desired corresponding spinal level(s) to be tested.
Barognosis refers to the ability to determine the approximate weight of an object.
Graphesthesia refers to the ability to recognize writing on the skin by touch. The practitioner can draw out a letter on the patients skin as a way of testing.
Kinaesthesia refers to ones own sense of body motion (excluding equilibrium which is controlled in part by the inner ear) and is commonly tested using the subject�s ability to detect an externally imposed passive movement, or the ability to reposition a joint to a predetermined position.
Proprioception is often assessed using the Rombergs test. This examination is based on the notion that a person requires at least two of the three following senses to maintain balance while standing: proprioception; vestibular function and vision. A patient who has a defect within their proprioceptive mechanism can still maintain balance by using vestibular function and vision. In the Romberg test, the patient is stood up and asked to close their eyes. A loss of balance is interpreted as a positive Romberg sign.
THE SPINOTHALAMIC TRACT CONVEYS INFORMATION ABOUT PAIN AND TEMPERATURE
A GOOD BRAIN CAN MODULATE PAIN
SPINOTHALAMIC TRACT
Pain is a complex sensation, in that a noxious stimulus leads not only to the perception of where it occurred but also to things such as a rapid increase in level of attention, emotional reactions, autonomic responses, and a greater likelihood that the event and its circumstances will be remembered. Corresponding to this complexity, multiple pathways convey nociceptive information rostrally from the spinal cord. One of them (the spinothalamic tract) is analogous to the posterior column�medial lemniscus pathway.
SPINOTHALAMIC TRACTS
Two main parts of the Spinothalamic Tract (STT)
Lateral Spinothalamic Tract
Transmission of pain and temperature
Anterior Spinothalamic Tract
Transmission of crude touch and firm pressure
DAMAGE TO THE ANTEROLATERAL SYSTEM CAUSES DIMINUTION OF PAIN AND TEMPERATURE SENSATIONS
Examination:
Given the role of the spinothalamic tract, the patient should be screened for any abnormalities regarding their sense of touch, pain, temperature, and pressure sensation.
Screening for such abnormalities is commonly done using gentle pin pricks and cotton wool, to contrast between sharp and soft, following cutaneous sensory nerve root distributions. Hot and cold discrimination can be ascertained using the cold metal arm of a tuning fork, and a warm palm or heated object.
2 Minute Neuroscience: Pain & The Anterolateral System
HAUSER ET AL. FIBROMYALGIA, 2015
�Pain processing and its modulation: Activation of peripheral pain receptors (also called nociceptors) by noxious stimuli generates signals that travel to the dorsal horn of the spinal cord via the dorsal root ganglion. From the dorsal horn, the signals are carried along the ascending pain pathway or the spinothalamic tract to the thalamus and the cortex. Pain can be controlled by nociception- inhibiting and nociception-facilitating neurons. Descending signals originating in the supraspinal centers can modulate activity in the dorsal horn by controlling spinal pain transmission. CNS, central nervous system.�
SPINAL INFORMATION REACHES THE CEREBELLUM BOTH DIRECTLY AND INDIRECTLY
The spinal cord is an important source of information used by the cerebellum in the coordination of movement. This information reaches the cerebellar cortex and nuclei both directly, by way of spinocerebellar tracts, and indirectly, by way of relays in brainstem nuclei. A number of spinocerebellar tracts have been described, some representing the upper extremity and others the lower extremity. Only three have been well characterized.
Ascending Tracts | Spinocerebellar Tract
DESCENDING PATHWAYS INFLUENCE THE ACTIVITY OF LOWER MOTOR NEURONS
The vast array of symptoms caused by neuropathy, also known as peripheral neuropathy, reflect the fact that it may be caused by an equally broad range of ailments involving disease and damage to peripheral nerves.
Contents
Signs and Symptoms of Neuropathy
Depending on the reason and unique to each patient, signs and symptoms of neuropathy can include:�pain; tingling, burning or prickling sensations; increased sensitivity to touch; muscle weakness or wasting;�temporary or permanent numbness; paralysis; dysfunction in glands or organs; or impairment in urination and sexual functioning.
Such signs and symptoms are dependent on whether autonomic, sensory, or motor nerves, as well as a combination of them, are ultimately affected. Autonomic nerve damage can influence physiological functions like blood pressure or create gastrointestinal problems and issues. Damage or dysfunction in the sensory nerves may impact sensations and sense of equilibrium or balance, while harm to motor nerves may affect movement and reflexes. When both sensory and motor nerves are involved, the condition is known as sensorimotor polyneuropathy.
Diabetic Neuropathy Symptoms
Diabetic peripheral neuropathy, which affects between 12 and 50 percent of individuals with diabetes, is one of the most common types of neuropathy. Many times, symptoms include a gradual change in sensation, as well as pain and weakness in the feet and, although less commonly, the hands. As the neuropathy develops further, it can lead to a loss of sensation in the affected regions.
This lack of feeling raises the odds of harm to the affected areas, explains Matthew Villani, doctor of podiatric medicine at Central Florida Regional Hospital at Lake Mary. Without the pain to signal when there’s an issue, individuals with diabetic neuropathy may allow modest abrasions or blisters on their feet, for instance, to fester as sores or ulcers. “The ulcers can become infected since they are open wounds, which can also progress to bone infection. Unfortunately, it frequently requires amputations if it does progress to that point”, states Dr. Matthew Villani.
Chemotherapy-Associated Neuropathy Symptoms
Cancer patients may suffer with neuropathy induced by chemotherapy as well as by other drugs and/or medications used to treat the disease. Symptoms can include intense pain, impaired movement, changes in heart rate and blood pressure, issues with balance, difficulty breathing, paralysis, and even organ failure. After chemotherapy is done, the symptoms frequently abate swiftly, but occasionally they last more, or these may not go away at all.
HIV- and AIDS-Associated Neuropathy Symptoms
Individuals being treated for HIV or AIDS can develop neuropathy from effects of the virus and the drugs and/or medications used to treat it as well. Common symptoms include stiffness, burning, prickling, tingling, and loss of feeling in the toes and soles of their feet. Sometimes the nerves in the fingers, hands, and wrists are also affected. The drugs Videx (didanosine), Hivid (zalcitabine), and Zerit (stavudine) have been most commonly associated with neuropathic symptoms.
Inflammation-Associated Neuropathy Symptoms
Inflammation caused by infections, like herpes zoster (also known as shingles), Lyme disease, or hepatitis B and hepatitis C, may lead to neuropathy, as may inflammation caused by autoimmune disorders, such as vasculitis, sarcoidosis, or autoimmune disease. In such situations, the signs and symptoms generally include burning and tingling sensations or numbness.
Other Causes of Neuropathy Symptoms
Additional causes of neuropathy and associated signs and symptoms include metabolic disorders, such as hypoglycemia or kidney failure; autoimmune disorders, such as rheumatoid arthritis, lupus, Sjogren’s syndrome, and Guillain-Barr� syndrome; toxicity; hereditary disorders, such as Charcot-Marie-Tooth disorder; hormonal disorders; alcoholism; vitamin deficiencies; physical trauma or injury; compression; and repetitive stress. In addition, many individuals may experience idiopathic neuropathy signs and symptoms, meaning that healthcare professionals may not know the reason for their neuropathy.
Dr. Alex Jimenez’s Insight
Neuropathy can be caused by a variety of injuries and/or aggravated conditions, often manifesting into a plethora of associated signs and symptoms. While every type of neuropathy, such as diabetic neuropathy or autoimmune disease-associated neuropathy, develops its own unique group of signs and symptoms, many patients will often report common complaints. Individuals with neuropathy generally describe their pain as stabbing, burning or tingling in character. If you experience unusual or abnormal tingling or burning sensations, weakness and/or pain in your hands and feet, it’s essential to seek immediate medical attention in order to receive a proper diagnosis of the cause of your specific signs and symptoms. Early diagnosis may help prevent further nerve injury.
What are the Common Signs and Symptoms of Neuropathy?
“Although there’s a wide array of signs and symptoms associated with neuropathy, the type of pain that people encounter may be common in many aspects of the disorder”, notes Vernon Williams, MD, a sports neurologist and director of the Center for Sports Neurology and Pain Medicine at Cedars-Sini Kerlan-Jobe Institute in Los Angeles. “The character and quality of neuropathic pain will often be pain that is burning or electric in character.” Furthermore, he describes that the pain will frequently be associated with different symptoms, like paresthesia, or a lack of normal sensation associated with pain; allodynia, or a painful reaction to a stimulus that wouldn’t normally trigger pain signals; and hyperalgesia, or a striking or severe pain in response to a stimulus that normally causes moderate pain.
How is Neuropathy Diagnosed?
If you think you’re having any of the above neuropathy signs and symptoms, consult a healthcare professional. A number of tests can be done to diagnose neuropathy. “There are certain patterns of complaints that indicate neuropathy,” stated Dr. Williams, “so taking down a patient’s history which includes a description of these complaints is an important first step.”
“After that, your healthcare professional can perform a physical evaluation, including checking motor and sensory function, assessing deep tendon reflexes, as well as looking for signs and symptoms like allodynia and hyperalgesia,” Williams says. “Then we can even perform electrodiagnostic testing; the most common being electromyography and nerve conduction testing, where we can stimulate nerves and document responses, calculate the rate at which signals are being transmitted and see whether there are some areas where nerves are not transmitting signals normally,” Williams continues.
With needle tests, Williams states, “We can put modest needles into human muscles, and, according to what we see and listen together with all the needle in the muscle, we get details about the way the nerves supplying those muscle tissues are functioning. There are a number of unique tests that could be handy to identifying neuropathy, in addition to localizing where the abnormality is the most likely to be coming from”, concluded Dr.�Vernon Williams.
Often, blood tests may test for elevated blood glucose to see whether your neuropathy signs and symptoms could possibly be associated to type 2 diabetes, nutritional deficiencies, toxic elements, hereditary disorders, and evidence of an abnormal immune response. Your healthcare professional may also do a nerve biopsy, which normally involves removing a small segment of a sensory nerve to search for abnormalities, or even a skin biopsy to see if there’s a reduction in nerve endings.
To give yourself the best chance of an accurate diagnosis as well as relief from your neuropathy signs and symptoms, be prepared to describe everything you are experiencing in detail, even when you experience them, how long an episode persists, and the amount of pain, discomfort or loss of sensation or movement you experience. The more specific you are on the signs and symptoms you’re experiencing, the easier it’ll be for your doctor to understand what’s happening. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
El Paso, TX. Chiropractor, Dr. Alexander Jimenez discusses the anatomy of nerve fibers, receptors, spinal tracts and brain pathways. Regions of the Central Nervous System (CNS) coordinate various somatic processes using sensory inputs and motor outputs of peripheral nerves. Important areas of the CNS that play a role in somatic processes are separated in the spinal cord brain stem. Sensory pathways that carry peripheral sensations to the brain are referred to an ascending pathway, or tract. Various sensory modalities follow specific pathways through the CNS. Somatosensory stimuli activate receptors in the skin, muscles, tendons, and joints throughout the entire body. The somatosensory pathways are divided into two separate systems based on the location of the receptor neurons. Somatosensory stimuli from below the neck run along the sensory pathways of the spinal cord, and the somatosensory stimuli from the head and neck travel through cranial nerves.
Contents
ANATOMY OF RECEPTORS, NERVE FIBERS, SPINAL CORD TRACTS AND BRAINSTEM PATHWAYS
RECEPTORS AND RECEPTOR BASED THERAPY
NEURONS NEED THREE THINGS TO SURVIVE!
FUNCTIONAL NEUROLOGY KEY CONCEPTS
The cell needs three things to survive.
Oxygen, glucose and stimulation.
Stimulation = Chiropractic, exercise, etc.
Stimulation leads to neuronal growth
Neuronal growth leads to plasticity
Subluxations alter the frequency of firing of neurons
Activation of one side will stimulate ipsilateral cerebellum and contralateral cortex (usually)
Proper stimulation CAN reduce pain.
CHIROPRACTIC IS RECEPTOR-BASED THERAPY
INTRODUCTION
The ongoing activity and output of the CNS are greatly influenced, and sometimes more or less determined, by incoming sensory information.
The basis of this incoming sensory information is an array of sensory receptors, cells that detect various stimuli and produce receptor potentials in response, often with astonishing effectiveness.
The health of the neuron, however, plays a huge role in how neurons can produce receptor potentials, the endurance of the neuron and the ability to create plasticity.
�Neurons that fire together, wire together.� Hebbian Theory
TYPES OF RECEPTORS
Chemoreceptors
Smell, taste, interoceptors
Thermoreceptors
Temperature
Mechanoreceptors
Cutaneous receptors for touch, auditory, vestibular, proprioceptors
Nociceptors
Pain
PARTS OF RECEPTORS
Although their morphologies vary widely, all receptors have three general parts:
1. Receptive Area 2. Area Rich In Mitochondria
Health of the neurons within the receptors will determine its response to stimulation
3. Synaptic Area To Pass Messages To The CNS
RECEPTIVE FIELDS
These are particular areas in the periphery where application of an adequate stimulus causes the receptors to respond.
Neurons in successive levels of sensory pathways (second- order neurons, thalamic and cortical neurons-also have receptive fields, although they may be considerably more elaborate than those of the receptors.
TRANSDUCTION
Sensory receptors use ionotropic and metabotropic mechanisms to produce receptor potentials
Sensory receptors transduce some physical stimulus into an electrical signal � a receptor potential � that the nervous system can understand.
Sensory receptors are similar to postsynaptic membranes as their adequate stimuli are analogous to neurotransmitters.
THE DIAMETER OF A NERVE FIBER IS CORRELATED WITH ITS FUNCTION
BIGGER = FASTER
Larger fibers conduct action potentials faster than do smaller fibers.
A? fibers are the largest and most rapidly conducting myelinated fibers.
The slowest conducting fibers of the body are the C fibers
RECEPTORS IN MUSCLES AND JOINTS DETECT MUSCLE STATUS AND LIMB POSITION
MUSCLE SPINDLES
Muscle spindles (Fig. 9-14) are long, thin stretch receptors scattered throughout virtually every striated muscle in the body.
These muscle spindles sense muscle length and proprioception (�one�s own� perception).
They are quite simple in principle, consisting of a few small muscle fibers with a capsule surrounding the middle third of the fibers.
These fibers are called intrafusal muscle fibers (fusus is Latin for �spindle,� so intrafusal means �inside the spindle�), incontrast to the ordinary extrafusal muscle fibers (�outside the spindle�).
The ends of the intrafusal fibers are attached to extrafusal fibers, so whenever the muscle is stretched, the intrafusal fibers are also stretched.
The central region of each intrafusal fiber has few myofilaments and is noncontractile, but it does have one or more sensory endings applied to it.
When the muscle is stretched, the central part of the intrafusal fiber is stretched, mechanically sensitive channels are distorted, the resulting receptor potential spreads to a nearby trigger zone, and a train of impulses ensues at each sensory ending.
GOLGI TENDON ORGANS
Golgi tendon organs are spindle-shaped receptors found at the�junctions between muscles and tendons. They are similar to Ruffini endings in their basic organization, consisting of interwoven collagen bundles surrounded by a thin capsule (Fig. 9-16).
Large sensory fibers enter the capsule and branch into fine processes that are inserted among the collagen bundles. Tension on the capsule along its long axis squeezes these fine processes, and the resulting distortion stimulates them.
If tension is generated in a tendon by making its attached muscle contract, tendon organs are found to be much more�sensitive and can actually respond to the contraction of just a few muscle fibers.
Thus Golgi tendon organs very specifically monitor the tension generated by muscle contraction and come into play whe
n fine adjustments in muscle tension need to be made (e.g., when handling a raw egg).
�
Thus the mode of action of Golgi tendon organs is quite different from that of muscle spindles (Fig. 9-17). If a muscle�contracts isometrically, tension is generated across its tendons, and the tendon organs signal this; however, the muscle spindles signal nothing because muscle length has not changed (assuming that the activity of the gamma motor neurons remains unchanged).
In contrast, a relaxed muscle can be stretched easily, and the muscle spindles fire; the tendon organs, however, experience little tension and remain silent. A muscle, by virtue of these two types of receptors, can have its length and tension monitored simultaneously.
Neuropathy affects about 8 percent of individuals over the age of 55. Your nervous system is composed of 2 parts: the central nervous system and the peripheral nervous system. The nerves of your peripheral nervous system transmit messages between your central nervous system, that is your brain and spinal cord, along with the rest of the body.
These nerves regulate a massive range of functions throughout the body, such as voluntary muscle movement, involving the motor nerves, involuntary organ action, through the autonomic nerves, and also the perception of stimuli, involving the sensory nerves. Peripheral neuropathy, which is often simply referred to as “neuropathy,” is a state that happens when your nerves become damaged or injured, often times simply disrupted. It’s estimated that neuropathy affects roughly 2.4 percent of the general populace and approximately 8 percent of people older than age 55. However, this quote doesn’t include people affected by neuropathy caused by physical trauma to the nerves.
Contents
Types of Neuropathy
Neuropathy can affect any of the three types of peripheral nerves:
Sensory nerves, which transmit messages from the sensory organs, such as the eyes, nose, etc., to your brain;
Motor nerves, which track the conscious movement of your muscles; and
Autonomic nerves, which regulate the involuntary functions of your own body.
Sometimes, neuropathy will only impact one nerve. This is medically referred to as mononeuropathy and instances of it include:
Ulnar neuropathy, which affects the elbow;
Radial neuropathy, which affects the arms;
Peroneal neuropathy, which affects the knees;
Femoral neuropathy, which affects the thighs; and
Cervical neuropathy, which affects the neck.
Sometimes, two or more isolated nerves in separate regions of the body can become damaged, injured or disrupted, resulting in mononeuritis multiplex neuropathy. Most often, however, multiple peripheral nerves malfunction at the same time, a condition called polyneuropathy. According to the National Institute for Neurological Disorders and Stroke, or the NINDS, there are over 100 kinds of peripheral neuropathies.
Dr. Alex Jimenez’s Insight
Neuropathy is medically defined as a disease or dysfunction of one or more peripheral nerves, accompanied by common symptoms of pain, weakness and numbness. The peripheral nerves are in charge of transmitting messages from the central nervous system, the brain and the spinal cord, to the rest of the body. Neuropathy can affect a wide array of nerves. It is also associated with numerous underlying medical conditions and it has been reported to affect approximately 20 million individuals in the United States alone. While physical trauma, infection or exposure to toxins can cause neuropathy, diabetes has been considered to be the most common cause for neuropathy.
Causes of Neuropathy
Neuropathies are often inherited from birth or they develop later in life. The most frequent inherited neuropathy is the neurological disease Charcot-Marie-Tooth disease, which affects 1 in 2,500 people in the USA. Although�healthcare professionals are sometimes not able to pinpoint the exact reason for an acquired neuropathy, medically referred to as idiopathic neuropathy, there are many known causes for them, including: systemic diseases, physical trauma, infectious diseases and autoimmune disorders.
A systemic disease is one which affects the whole body. The most frequent systemic cause behind peripheral neuropathy is diabetes, which can lead to chronically high blood glucose levels that harm nerves.
A number of other systemic issues can cause neuropathy, including:
Kidney disorders, which permit high levels of nerve-damaging toxic chemicals to flow in the blood;
Toxins from exposure to heavy metals, including arsenic, lead, mercury, and thallium;
Certain drugs and/or medications, including anti-cancer medications, anticonvulsants, antivirals, and antibiotics;
Chemical imbalances because of liver ailments;
Hormonal diseases, including hyperthyroidism, which disturbs metabolic processes, potentially inducing cells and body parts to exert pressure on the nerves;
Deficiencies in vitamins, such as E, B1 (thiamine), B6 (pyridoxine), B12, and niacin, that can be vital for healthy nerves;
Alcohol abuse, which induces vitamin deficiencies and might also directly harm nerves;
Cancers and tumors that exert damaging pressure on nerve fibers and pathways;
Chronic inflammation, which can damage protective tissues around nerves, which makes them more vulnerable to compression or vulnerable to getting inflamed and swollen; and
Blood diseases and blood vessel damage, which may damage or injure nerve tissue by decreasing the available oxygen supply.
Additionally, if a nerve suffers from isolated bodily injury, it can become damaged, resulting in neuropathy. Nerves may suffer a direct blow that severs, crushes, compresses, or stretching them, even to the point of detaching them from the spinal cord. Common causes for these injuries are automobile accidents, falls, and sports injuries.
Nerve damage can also arise from powerful pressure on a nerve, like from broken bones and poorly fitted casts. Prolonged pressure on a nerve can also cause neuropathy, as in carpal tunnel syndrome, which occurs when the median nerve at the wrist becomes pinched. Also, persistent physical stress could inflame muscles, tendons, and ligaments, placing substantial pressure on the nerves.
Numerous infections from bacteria and viruses can lead to neuropathy by attacking nerve tissues directly or indirectly, for instance:
HIV
Shingles
Epstein-Barr virus
Lyme disease
Diphtheria
Leprosy
In addition, various autoimmune disorders, in which the body’s immune system attacks and destroys body tissue that is healthy, may result in nerve damage, including:
Peripheral neuropathy may result in several complications, as a result of disease or its symptoms. Numbness from the ailment can allow you to be less vulnerable to temperatures and pain, making you more likely to suffer from burns and serious wounds. The lack of sensations in the feet, for instance, can make you more prone to developing infections from minor traumatic accidents, particularly for diabetics, who heal more slowly than other people, including foot ulcers and gangrene.
Furthermore, muscle atrophy may cause you to develop particular physical disfigurements, such as pes cavus, a condition marked by an abnormally high foot arch, and claw-like deformities in the feet and palms. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
If you have lower back or buttocks pain which runs into your thigh or past the knee to one leg and foot, a healthcare professional may diagnose your symptoms as sciatica. Sciatica is a medical term used to describe painful sensations caused by the compression or impingement of the sciatic nerve. This compression is normally caused by a disc herniation or a bone spur pressing on one of the nerves in the lower back.
Sensations, or unusual feelings, could include numbness, tingling, pins and needles, and sometimes pain referred to as electric-shock-like. Determined by the individual nerve that is affected, pain may radiate only into the buttocks or all the way down to the foot.
Sciatica pain generally radiates along the length of the sciatic nerve, the longest and largest nerve in the human body, usually from the lower back, down the buttocks, and into the thigh and leg as well as the foot. One hallmark of classic sciatica is when the painful symptoms are felt beneath the knee and sometimes down into the foot and great toe. Usually, sciatica only affects one side of the body, however, it may occasionally affect both sides of the body.
Contents
Radicular Pain or Radiculopathy
Radicular pain, or radiculopathy, are different terms used to describe similar symptoms. Your healthcare professional may commonly utilize these terms interchangeably while discussing your sciatica. Radiculopathy is pain and/or an adverse sensation that travels past the affected site, along the length of a nerve. When a spinal nerve root is compressed, pinched or injured, it may become inflamed. Common conditions which could cause this kind of problem are spinal stenosis, foraminal stenosis or herniated discs.
What to Expect from a Sciatica Diagnosis
In order to determine the proper diagnosis of your sciatica symptoms, a healthcare professional may ask a series of questions, for instance:
When did the pain begin?
Where do you feel the pain?
What activities worsen or reduce pain and symptoms?
Does the pain go all the way down your leg or does it stop at the knee?
Is there weakness or tingling in your thighs or feet?
How severe is your pain, on a scale of 1 to 10? (10 being the worse pain possible)
The healthcare professional may conduct a straight-leg test to find out whether you’ve got irritation or inflammation on a nerve. In order to perform this evaluations, you lie on your back while the doctor lifts each leg. When lifting a leg causes, or generates sciatic-like pain and sensations, you might have a bulging or ruptured disc, best known as a disc herniation.
Furthermore, the healthcare professional may ask you to walk as you normally do, then on your heels and next on your toes. This enables the physician to confirm your balance and aspects of lower-body strength. Compression or impingement of the sciatic nerve may cause muscle fatigue in the foot that will be revealed by these tests and evaluations. During your examination, your healthcare professional will:
Look at your position and range of movement
Note any movement that causes pain
Examine the curvature and alignment of your spine
Feel for muscle strain
Assess your sensation
Test your reflexes and muscle strength
Your doctor may order a plain x-ray, CT scan or MRI to help see the source of your sciatica more clearly. The CT scan or MRI provides the doctor with several snapshots of your spine, and will help confirm a suspected diagnosis. The findings of an imaging test are compared to the information that the doctor gathers during the taking of your medical history, and physical and neurological examination outcomes. An accurate identification is one of the very first steps in determining the best treatment options.
If it’s not Sciatica, What Else Could it Be?
Only a healthcare professional can tell for sure if your symptoms are sciatica or not. There are many complex structures in the spine which can result in similar kinds of pain. For instance, the joint between the pelvic and sacrum, or the sacroiliac joint, or SI joint, which is the smallest portion of the spine, may lead to pain from the buttock in the case of injury or due to an aggravated condition. You may also feel sciatica-like pain and discomfort if you sprain a very low back facet joint, which are the connecting joints at the back region of the spine. A tear in a disk can lead to pain down to the leg. The hip joint can occasionally trigger pain at the thigh as well. It’s essential to seek proper medical attention to assess the source of your symptoms.
Sciatica Treatment
Treatments for sciatica pain are diverse and there are lots of options to choose from. While sciatic nerve pain and radicular pain symptoms may resolve with the use of many traditional and alternative treatment options, severe cases may require surgery. Normally, some middle ground of these two extremes is the answer for curing sciatica.
Sciatica usually may be treated nonsurgically with short (24 to 48 hours) bed rest and pain relievers like aspirin or acetaminophen. In some cases, the physician may prescribe drugs and/or medications that relieves nerve pain, such as gabapentin. Oral steroids are another commonly used treatment to calm pain down. Typically, patients with sciatica feel better over time, generally in a few weeks. If pain persists, however, injections might be discussed. Muscle cramps, which might accompany sciatica symptoms, might be treated with heat or cold. Your physician will tell you to take brief walks, and might prescribe physical therapy. Once you recover, your doctor may also give you exercises to strengthen your back.
Can Chiropractic Care Treat Sciatica?
Chiropractic care is one of the top treatment options used for sciatica pain. Utilizing a variety of methods and techniques, chiropractic care doesn’t simply reduce the symptoms, it can ultimately fix the health issues associated with sciatica and prevent further circumstances of the collection of symptoms.
A good chiropractic care regimen might include spinal adjustments and manual manipulations, passive therapies, spinal decompression, massage therapy, and physical therapy to help reduce pain and correct the underlying problem causing it. A great chiropractic solution is going to be a plan which entails many or all of the above mentioned remedies as determined by your personal needs and recovery timeline. Furthermore, a chiropractor may recommend a series of appropriate stretches and exercises to help speed up the recovery process and promote a long-lasting recovery so you can live a pain-free life.
Dr. Alex Jimenez’s Insight
Sciatica is a medical term used to describe a collection of symptoms, including, pain, numbness or tingling sensations, caused by the compression or irritation of the sciatic nerve in the lower back. Although symptoms of sciatic nerve pain, or sciatica, are commonly concentrated in the lower back, radiating pain or radiculopathy may sometimes occur along the length of the sciatic nerve. A bulging or herniated disc is one of the most prevalent health issues which lead to sciatica. It’s essential to receive a proper diagnosis of any painful symptoms in order to follow-up with the best treatment options. Chiropractic care can help treat sciatica through the use of spinal adjustment and manual manipulations, among other treatment modalities, by carefully restoring the original alignment of the spine and reducing nerve compression and irritation associated with sciatic nerve pain.
If you believe that you are suffering from sciatic nerve pain, then consider the chiropractic care alternative solution. Many chiropractors can help by building a customized restoration plan around your requirements and goals. With years of experience, friendly employees, and innovative equipment, the proper chiropractor will get you back to normal the natural way. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
Causes
Radiculopathy
Testing Cervical Nerve Roots
Testing Lumbosacral Nerve Roots
Stocking & Glove Pattern
Erb�s Palsy
Klumke�s Palsy
Entrapment Neuropathies
Median N. Pronator Teres Syndrome
Tinel�s Sign
Etiology
The term posterior column refers to the entire contents of a posterior funiculus, exclusive of its share of the propriospinal tract. The posterior columns consist mainly of ascending collaterals of large myelinated primary afferents carrying impulses from various kinds of mechanoreceptors (although substantial numbers of second-order fibers and unmyelinated fibers are also included). This has traditionally been considered the major pathway by which information from low-threshold cutaneous, joint, and muscle receptors reaches the cerebral cortex.
The cell needs three things to survive.
The health of the neuron, however, plays a huge role in how neurons can produce receptor potentials, the endurance of the neuron and the ability to create plasticity.
Chemoreceptors
Although their morphologies vary widely, all receptors have three general parts:
Sensory receptors use ionotropic and metabotropic mechanisms to produce receptor potentials
Larger fibers conduct action potentials faster than do smaller fibers.
junctions between muscles and tendons. They are similar to Ruffini endings in their basic organization, consisting of interwoven collagen bundles surrounded by a thin capsule (Fig. 9-16).
sensitive and can actually respond to the contraction of just a few muscle fibers.
