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$Unique_ID{BRK04048}
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$Title{Neuropathy, Peripheral}
$Subject{Neuropathy Peripheral Peripheral Neuritis Mononeuropathy Mononeuritis
Mononeuritis Multiplex Polyneuropathy Polyneuritis Multiple Peripheral
Neuritis Ulnar Nerve Palsy Tardy Ulnar Palsy Carpal Tunnel Syndrome Peroneal
Nerve Palsy Radial Nerve Palsy, also known as Saturday Night Palsy }
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Copyright (C) 1987, 1989, 1991 National Organization for Rare Disorders, Inc.

246:
Neuropathy, Peripheral

** IMPORTANT **
It is possible the main title of the article (Peripheral Neuropathy) is
not the name you expected.  Please check the SYNONYMS listing to find the
alternate names and disorder subdivisions covered by this article.

Synonyms

     Peripheral Neuritis
     Mononeuropathy
     Mononeuritis
     Mononeuritis Multiplex
     Polyneuropathy
     Polyneuritis
     Multiple Peripheral Neuritis
     Ulnar Nerve Palsy
     Tardy Ulnar Palsy
     Carpal Tunnel Syndrome
     Peroneal Nerve Palsy
     Radial Nerve Palsy, also known as Saturday Night Palsy

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.


Peripheral Neuropathy is a syndrome characterized by sensory, motor,
reflex and blood vessel (vasomotor) symptoms.  These symptoms can occur
singly or in any combination.

Symptoms

The symptoms of Peripheral neuropathy are produced by disease of a single
nerve (mononeuropathy, mononeuritis), several nerves in asymmetric areas of
the body (mononeuritis multiplex), or many nerves simultaneously
(polyneuropathy, polyneuritis, multiple peripheral neuritis).  These symptoms
may involve sensory, motor, reflex, or blood vessel (vasomotor) function.
Lesions, usually degenerative and rarely accompanied by signs of
inflammation, may occur in the nerve roots or peripheral nerves.

Mononeuritis or mononeuropathy is characterized by pain, weakness, and
abnormal sensations (paresthesias) in the area that is innervated by the
affected nerve.  In mononeuritis multiplex all the affected nerves may be
involved from the outset or become involved progressively.  Extensive
involvement of many nerves often resembles the symptoms of polyneuropathy.

Compression and entrapment neuropathies result from malfunction of a
nerve caused by mechanical means.  Paralysis around the elbow (ulnar nerve
palsy) is caused by trauma or pressure on the nerve in the ulnar groove of
the elbow.  This can occur as the result of repeated leaning on the elbow or
by abnormal bone growth after a childhood fracture ("tardy ulnar palsy").
Unusual sensations and sensory deficits in the 4th and 5th fingers can be
accompanied by weakness and atrophy of:

1) the muscle that pulls the thumb to the hand (adductor)
2) a muscle on the lateral side of the 5th finger (abductor)
3) muscles between the bones in the hand adjacent to 4th and 5th fingers.

The carpal tunnel syndrome results from compression of the median nerve
in the wrist between the tendons of forearm muscles and the carpal ligament
in the hand.  This compression can produce abnormal sensations in the hand
plus pain in the wrist, the palm, or sometimes proximal to the compression
site in the forearm.  Commonly, patients feel that their hand "falls asleep"
often.  Carpal tunnel syndrome is relatively common.  It may occur in one or
both hands and it is seen more often in women.  It often occurs in patients
with acromegaly, myxedema, rheumatoid arthritis and also in people with
occupations that require repeated forceful wrist flexion (e.g. carpenters).

Peroneal nerve palsy is caused by compression of the nerve against the
lateral side of the fibula in the leg.  It is most common in emaciated
nonambulatory patients and in thin people who habitually cross their legs.
Weakness when bending the foot upward (dorsiflexion) and foot drop may occur.
Occasionally, a sensory deficit is found on the dorsal side of the web
between the first and second long bones in the foot (metatarsals).

Radial nerve palsy ("Saturday night palsy") is caused by compression of
the radial nerve in the upper arm (e.g. when the arm is draped over the back
of a chair for long periods of time).  Symptoms include weakness of wrist and
finger stretching (extensor) muscles, wrist drop, and occasionally a sensory
loss on the dorsal web between 1st and 2nd metatarsals.

The site of local nerve damage can be identified by Tinel's sign, a
distal abnormal sensation in the area that is innervated by the nerve when
the region over the nerve is tapped.  Electrical nerve conduction studies
also help to identify the location of the nerve damage.  Polyneuropathy is
usually bilaterally symmetric, and all nerves (sensory, motor, vasomotor, or
a combination) are involved at the same time.

There are several forms of polyneuropathy.  The most common form is seen
with metabolic diseases, diabetes mellitus or malnutrition.  This form
develops slowly, often over months or years, and often begins with sensory
abnormalities in the legs.  Peripheral tingling, numbness, burning pain, or
deficiencies in perception of joints and vibratory sensation are often
prominent.  Pain is often worse at night and may be aggravated by touching
the affected area or by temperature changes.  In severe cases, signs of
sensory loss can be demonstrated, characteristically in the area that would
be covered by stockings and gloves.  The Achilles and other deep tendon
reflexes are diminished or absent.  Painless ulcers on the fingers and toes
or Charcot's joints may be seen when sensory loss is profound.  Sensory or
joint perception deficits may lead to abnormal posture or gait that simulate
a kind of clubfoot.  Weakness and atrophy of distal limb muscles and flaccid
tone characterize involvement of motor nerve fibers.

The autonomic nervous system may be additionally involved, leading to
diarrhea at night, bladder and bowel incontinence, impotence, or postural low
blood pressure.

An exclusively sensory polyneuropathy is sometimes seen in lung cancer
originating in the bronchi.  This often begins with pain and abnormal
sensations and progresses to a loss of all forms of sensation.

Causes

Peripheral Neuropathy may have many different causes.  These include:

1.  Mechanical stress such as compression, direct trauma, penetrating
injuries, contusions, tearing away of a nerve by fracture, or dislocation of
bones can cause mononeuritis and sometimes mononeuritis multiplex.

2.  Pressure paralysis usually affects superficial nerves such as ulnar,
radial or peroneal, when they are adjacent to bony prominences (e.g. during
sound sleep or anesthesia in thin or weakened persons and frequently in
alcoholics).  It may affect nerves in narrow canals such as in the entrapment
neuropathies (e.g., the median nerve in the carpal tunnel syndrome).
Pressure paralysis may also result from tumors, bony hyperostosis, use of
casts, crutches, or prolonged cramped postures (e.g. while gardening).

3.  Violent muscular activity or forcible overextension of a nerve may
produce a mechanical neuritis, as may small traumas such as those encountered
by engravers through tight gripping of small tools, or by air-hammer
operators through excessive vibration.

4.  Hemorrhage into a nerve and exposure to cold or to radiation may also
cause neuropathy.

5.  Vascular or collagen disorders such as polyarteritis nodosa,
atherosclerosis, systemic lupus erythematosus, scleroderma, sarcoidosis and
rheumatoid arthritis can cause mononeuritis multiplex (for information on
these disorders, see those articles in the Rare Disease Database).

6.  Volkmann's ischemic paralysis occurs when closing off (occlusion) of
a major artery affects nerves with a common blood supply in one limb.

Related Disorders

Guillain-Barre syndrome (acute idiopathic polyneuritis) occurs when the
body's immune system attacks the nerves, damaging the nerves' myelin sheath
and sometimes the axon.  Nerve signals are delayed and altered, causing
weakness and paralysis of the muscles of the legs, arms and other parts of
the body along with abnormal sensations.  (For more information on Guillain-
Barre syndrome, choose Guillain-Barre as your search term in the Rare Disease
Database.)

Carpal tunnel syndrome resembles the symptoms of cervical nerve 6 root
compression due to cervical osteoarthropathy.  (For more information on this
disorder, choose "Carpal Tunnel" as your search term in the Rare Disease
Database.)

Therapies:  Standard

Recovery may be complete or incomplete with sensory, motor or vasomotor
residual and, in severe cases, chronic muscular atrophy as well.

Specific therapy is directed at the cause such as control of diabetes,
administration of vitamins or proper diet, avoiding further mechanical trauma
or surgery when tumors or ruptured intervertebral disks are involved.

Stitching a nerve together, surgically breaking up adhesions around a
nerve (neurolysis), or nerve transplant may be advisable in some traumatic
lesions.

In peripheral nerve entrapment or compression neuropathy (i.e. carpal
tunnel syndrome), splinting or surgical decompression of the ulnar or median
nerves is often beneficial.

Peroneal and radial compression neuropathies are treated by avoiding
pressure on the areas.  Recovery is often slow, and physical therapy or
splints may help to avoid contractures.

Therapies:  Investigational

Cronnassial is being tried on an experimental basis to treat the
cardioneuropathy effects of Chagas Disease and other Peripheral Neuropathies.
The drug is under study in the United States but is not commercially
available here.  Trials are being sponsored in the U.S. by Rorer.  The drug
is available in other countries including Italy, Austria, Spain, and
Argentina.  It is manufactured by Fidia in Italy.

     Fidia Farmaceutici Italiani Industriali e Affini
     Via Ponte della Fabbrica 3/A
     35051 Abano Terme (Padova) Italy
     049-810-444

This disease entry is based upon medical information available through
November 1991.  Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate.  Please check with the agencies listed in the Resources section for
the most current information about this disorder.

Resources

For more information on Peripheral Neuropathy, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     NIH/National Institute of Neurological Disorders & Stroke (NINDS)
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]
     [phone]

References

THE MERCK MANUAL 15th ed:  R. Berkow, et al:  eds; Merck, Sharp & Dohme
Research Laboratories, 1987.  P. 1443.

CECIL TEXTBOOK OF MEDICINE, 18th ed.:  James B. Wyngaarden, and Lloyd H.
Smith, Jr., Eds.:  W. B. Saunders Co., 1988.  P. 507.