Differential Diagnosis and Operative Indication of Peripheral Nerve Entrapment Neuropathy and Future Perspective

<p>  Many patients come to the hospital with complaints of numbness and pain in their upper and lower limbs. In this situation, the most important thing in conducting a differential diagnosis is to ensure that the proper neurological examinations are conducted. The brain, spinal cord, nerve roots and peripheral nerves are the responsible sites for neurological symptoms. After making a conceivable diagnosis by consolidating the patients symptoms and neurological examination results, we perform imaging and electrophysiological studies and finally determine the affected site. Some of the more common peripheral nerve entrapment neuropathies are carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, peroneal nerve entrapment neuropathy, tarsal tunnel syndrome and so on. In peripheral nerve entrapment disorders, comprehending the skin innervation area of numbness or pain is a key point in making an accurate diagnosis. Tinel’s sign and symptom induction tests according to patient some posture are still very useful in the diagnosis of peripheral nerve disorders. Recently, imaging studies such as MRI and high-resolution ultrasonography have been developed and have become more reliable for diagnosing of the severity of the nerve degeneration, but electrophysiological examination is still important. For peripheral nerve entrapment disorders, immobilization or rest of the affected site is very useful in the early stage, and conservative treatment such as physical therapy and medication therapy should also be performed. Surgical treatment might be recommended for the cases with severe symptoms, symptom progression and daily life impairment by severe pain.</p><p>  Japan is different from other countries in the point of clinical practice. Neurosurgeons must diagnose the disease, perform surgeries and then take care of patients. As the diagnosis, surgery and postoperative follow-up are not independent for Japanese neurosurgeons, so patient feedback can be reliably obtained, which may contribute to improving the diagnostic ability and surgical techniques. Although neurologists are also involved in diagnosis and orthopedic surgeons are also involved in the surgical treatment, surgical treatment for peripheral nerve entrapment disorders should be guided in the future by neurosurgeons who can handle the whole nervous system.</p>