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- Fakultät WiSo (22)
Nervenkompressionssyndrome („Engpass-Syndrome“) wie Karpaltunnelsyndrom, Radikulopathien oder radikulärer Schmerz sind die häufigsten peripheren Nervenläsionen und auch die häufigste Ursache für neuropathischen Schmerz. Trotz ihrer hohen Prävalenz stellen sie diagnostisch und therapeutisch weiterhin oft eine klinische Herausforderung dar. Die vorliegende Übersicht bietet aktuelle Informationen zur Ätiologie und Pathophysiologie von Nervenkompressionssyndromen; dafür wird die Evidenz aus präklinischen wie auch klinischen Studien zusammengefasst. Mögliche Mechanismen werden in den Kontext klinischer Befunde gestellt. Das aktuelle diagnostische Vorgehen wird erörtert, diagnostische Fallstricke werden beleuchtet. Zuletzt fasst der Beitrag die Evidenz für die nichtinvasive und chirurgische Therapie häufiger Nervenkompressionssyndrome zusammen und zeigt zukünftige Forschungsbereiche auf.
Comparison of quantitative sensory testing profles between people living in Germany and Australia
(2021)
Entrapment neuropathies such as carpal tunnel syndrome, radiculopathies, or radicular pain are the most common peripheral neuropathies and also the most common cause for neuropathic pain. Despite their high prevalence, they often remain challenging to diagnose and manage in a clinical setting. Summarising the evidence from both preclinical and clinical studies, this review provides an update on the aetiology and pathophysiology of entrapment neuropathies. Potential mechanisms are put in perspective with clinical findings. The contemporary assessment is discussed and diagnostic pitfalls highlighted. The evidence for the noninvasive and surgical management of common entrapment neuropathies is summarised and future areas of research are identified.
Entrapment neuropathies are a heterogenous condition reflecting distinct underlying pathomechanisms. A contemporary assessment aimed at identifying potential mechanisms may help target management for these patients.
Wir kennen neurodynamische Tests und Behandlungsmethoden, nutzen diese alltäglich in der Praxis und gehen auf Kurse, um mehr darüber zu lernen. Aber was verstehen wir tatsächlich darunter? Kommen wir in unserem Verständnis darüber auf einen gemeinsamen Nenner? Dieser Artikel gibt einen Einblick in die Thematik Neurodynamik. Bisherige Überzeugungen stehen dabei auf dem Prüfstand.
Nervenschmerz ist nicht gleich Nervenschmerz. Um Patienten mit ausstrahlenden Schmerzen, bei denen die Nerven eine Rolle spielen könnten, adäquat zu therapieren, sind eine gründliche Untersuchung und ein fundiertes Clinical Reasoning unerlässlich. Nur dadurch entpuppen sich die beiden Patientinnen mit fast identischen Symptomen als sehr unterschiedlich.
Entrapment neuropathies are the most prevalent type of peripheral neuropathy and often a challenge to diagnose and treat. To a large extent, our current knowledge is based on empirical concepts and early (often biomechanical) studies. This Viewpoint will challenge some of the current beliefs with recent advances in both basic and clinical neurosciences.
Neurotension – Gestern und Heute. Wie ist der momentane Kenntnisstand, und wie setze ich ihn um?
(2018)
Characterisation of pain in people with hereditary neuropathy with liability to pressure palsy
(2017)
Hereditary neuropathy with liability to pressure palsy (HNPP) has historically been considered a pain-free condition, though some people with HNPP also complain of pain. This study characterised persistent pain in people with HNPP. Participants provided cross-sectional demographic data, information on the presence of neurological and persistent pain symptoms, and the degree to which these interfered with daily life. The painDETECT and Central Sensitization Inventory questionnaires were used to indicate potential neuropathic, central sensitisation and musculoskeletal (nociceptive) pain mechanisms. Additionally, participants were asked if they thought that pain was related to/part of HNPP. 32/43 (74%) subjects with HNPP had persistent pain and experience this pain in the last week. Of those with pain, 24 (75%) were likely to have neuropathic pain and 27 (84%) were likely to have central sensitisation. All 32 participants felt that their pain could be related to/part of their HNPP. Significant negative impact of the pain was common. Pain characterisation identified neuropathic pain and/or central sensitisation as common, potential underlying processes. Pain may plausibly be directly related to the underlying pathophysiology of HNPP. Further consideration of including pain as a primary symptom of HNPP is warranted.
Objectives
The aims of the present study were to provide back pain (BP) point prevalence data from inpatients at an Australian tertiary hospital on one day, and compare this with Australian non-hospitalized population prevalence data; to collect data around the development of BP throughout hospital admission; and to analyse the association between BP and past history of BP, gender, age, admission specialty and hospital length of stay (LOS).
Methods
This was a single-site, prospective, observational study of hospitalized inpatients on one day during 2016, with a subsequent survey over the following 11 days (unless discharge or death occurred sooner).
Results
Data were collected from 343 patients (75% of the hospitalized cohort). A third of patients (n = 108) reported BP on admission, and almost a fifth (n = 63) developed new BP during their hospitalization. Patients who described BP at any time during their hospital stay had a higher chance of having had a history of BP, with odds increasing after adjustment for age and gender (odds ratio 5.89; 95% confidence interval (CI) 3.0 to 11.6; p < 0.001). After adjusting for age and gender, those experiencing BP had a significantly longer LOS (median 13 days; CI 10.8 to 15.3) than those who did not (median 10 days; CI 8.4 to 11.6; p = 0.034).
Conclusions
Hospital LOS for patients who complained of BP at any time during their admission was 3 days longer than those who had no BP, and a history of BP predicted a higher likelihood of BP during admission. Screening of patients on admission to identify any history of BP, and application of a package of care including early mobilization and analgesia may prevent the onset of BP and reduce LOS.