Thursday, July 09, 2009

Advice for chronic neck pain and what is compression neuropathy

Advice for a patient suffering from chronic neck pain

Compression neuropathies

It is a well-known fact that compression neuropathies in upper extremities are really common which are recognized frequently. The prevalence of combination of morbid and common obesity in aging population suggests the problem of upper extremity compression neuropathy will rise up in the next 10 years. In 1990s, etiologic relation between occupation and nerve compression disorders was really controversial but nowadays existence of multilevel neural compression is generally recognized, but work-relatedness of these conditions is still debated.

Except for significant exposure to vibration and some specific occupations with a high incidence of carpal tunnel syndrome, it is generally accepted that work is just one component of many factors that contributes to and aggravate compression neuropathy.

As compared with other compression neuropathies in the upper extremity, carpal tunnel syndrome, in general, is managed less successfully with nonoperative treatment.

The surgeon who treats nerve compression of the upper extremities should be aware of many other neurologic problems, for example Parsonage-Turner syndrome, brachial plexus neuritis, motor neuropathies, and mononeuritis which can mimic or correlate to entrapment neuropathies and mostly do not respond to surgical procedures.

In a recent survey, it has been found that there is a group of individuals who are sensitive to development of compression neuropathies genetically. Some systemic factors including diabetes, obesity and thyroid disease have found to be related to these problems.

Pathophysiology Of Chronic Nerve Compression

Clinical presentation of patients having chronic nerve compression is variable and it reflects broad-spectrum histopathologic changes that may occur in the nerve.

In some patients with associated morbidity, neural tissue biopsy could not be performed and most of the knowledge and info about histopathology of human compression neuropathies is estimated from animal models.

Some studies done by renowned medical practitioners suggest neural ischemia contributing to nerve compressions; however, many of these studies reflect acute changes, which occur with compression. Many animal models have been shown that use different types of techniques to induce chronic nerve compression, but there is a concern about the potential for Silastic to induce reactive effects on a nerve. The histologic changes seen in the Silastic cuff model are essentially identical to those seen in the few histologic studies of chronic nerve compression that have been published.

Medical researchers have reported limited tissue reaction around the silicone tubes 1 year after human nerve repairs. The continuum of neural changes that occur will depend on the force of compression and the duration of compression. The histopathologic changes that occur with chronic nerve compression begin with breakdown in the blood-nerve barrier, followed by endoneurial edema and, subsequently, by perineurial thickening. Increased endoneurial pressure will result in changes in the microneural circulation and render the nerve susceptible to dynamic ischemia. With increased compression, there will be localized demyelination, followed by more diffuse demyelination and finally axonal degeneration. Neural changes may not occur uniformly across the nerve and may vary depending on the distribution of compressive forces across the nerve. Superficial fascicles will undergo changes sooner and may result in varying patient symptoms within a single nerve distribution.

Pathophysiology Of Chronic Nerve Compression

For example, in early carpal tunnel syndrome, the superficial fascicles to the long finger and ring finger are usually affected before the fascicles to the thumb and radial side of the index finger. Patient sensory complaints will generally parallel the histopathologic neural changes and will progress from intermittent paresthesia to persistent numbness.

Sensory testing will also vary with the degree of nerve compression. Initially, patients will have alteration in threshold measures and, with more severe nerve compression, will progress to deficits in two-point discrimination.

London Olympics 2012

How successful will be London Olympics 2012?

The London Olympics will be really successful because of large redevelopment of most-deprived areas of east London. People and sponsors are investing tens of billions of money into the region where Olympics is going to be held and all these combined together will totally redevelop the area and it will ready for modern urban life.