Fascial entrapment neuropathy

Abstract

Entrapment neuropathies are debilitating clinical conditions, creating significant morbidity in the upper and lower extremities in terms of pain, sensory abnormalities, and motor weakness, becoming a challenge to diagnose and treat. Because entrapments can have multiple origins, a misinterpretation of anatomy during examination can lead to incorrect diagnosis and treatment. This review addresses understanding of the anatomy of fascia that can play an important role in this syndrome. There is a specific microenvironment around the nerve composed of connective tissues that include deep fascia, intermuscular septa, epineurium, and perineurium. The microenvironmental modifications can be translated into change in mobility with consequence decreasing of the independency of the nerve from the surrounding structures lading to entrapments and “internal stretch lesion.” The entrapments reported in this article reinforce the importance of fascia tissue in generating common symptoms that pose more difficult diagnostic challenges and may often be confused with more common clinical conditions. Clin. Anat. 32:883–890, 2019. © 2019 Wiley Periodicals, Inc.

Ultrasound imaging and Fascial Manipulation® for rigid retinacula in two cases of complex regional pain syndrome

“…Herein, abnormal thickness and stiffness of the ankle retinacula may be indirect signs of the transmission alteration of the line forces inside the deep fascia of the whole lower limb, stretching/compressing the superficial fibular and sural nerves [7]. Yet, the tension (due to stiff oblique superomedial band of the inferior extensor retinaculum) on the crural fascia is possibly transferred to those nerves, affecting mostly the thin non-myelinated axons commonplace in the superficial parts of the nerve fascicles [8][9][10]. Herein, as the superficial nerves have more endo/peri/epineurium tissue components compared to the more deeply located nerves [11], it is likely that they suffer a biomechanical tension/stretch/compression manifesting only with autonomic dysregulation.…”

Dorsal Root Ganglion Stimulation Lead Fracture Within the Superficial Fascial Layers in 4 Cases

“…This multiplanar course can cause an “internal stretch lesion” due to stress and tension on the nerve. 14 These types of injuries are often difficult to diagnose and can explain why traditional nerve release procedures may be inadequate in treating focal nerve injuries and require dissection of the fascia layers. 15 …”

Ultrasound Imaging of the Fascial Layers: You See (Only) What You Know

“…Accordingly, sonographers have started to evaluate and quantify many (new) structures that they could not “see” before . The fascia is actually one of those interesting structures, and its pathologic characteristics are worth discussing with regard to our daily practice . On the other hand, to simplify anatomy training (and sometimes because they are deemed unimportant), fasciae are likely to be underrated in the recent anatomy literature.…”