Reappraising entrapment neuropathies – Mechanisms, diagnosis and management.

The diagnosis of entrapment neuropathies can be challenging because symptoms and signs frequently don’t follow textbook descriptions and vary substantially between patients with the same diagnosis. Signs and symptoms which spread beyond the innervation territory of the affected nerve or nerve root are common. This Masterclass provides insight into relevant mechanisms that may be cause this extraterritorial spread in patients with entrapment neuropathies, with an emphasis on neuroinflammation at the level of the dorsal root ganglia and spinal cord, as well as changes in subcortical and cortical regions. Furthermore, they describe how clinical tests and technical investigations may identify these mechanisms if interpreted in the context of gain or loss of function. The management of neuropathies also remains tricky. Common treatment strategies such as joint mobilisation, neurodynamic exercises, education, and medications are discussed in terms of their potential to influence certain mechanisms at the site of nerve injury or in the central nervous system.

It is concluded by the authors that the mechanism-oriented approach for this Masterclass seems called for when one considers the limitations in the current evidence for the diagnosis and management of entrapment neuropathies.