New Mexico Chiropractic Association Journal

Information on nerve disease:
(Reference, Neurology by Bernat and Vincent)
by J. B. Brock, DC, CCN, CCRD, DACNB

 


The term neuropathy is a broad term that basically states that there is a disease process of a nerve, it does not denote why, what kind or where the lesion on the nerve is, it is just a general term.

Peripheral neuropathy is just what is says it is. In this scenario there is entrapment or damage to the nerve in the periphery, these areas include but are not limited to the carpal tunnel, tunnel of guyon, cubital tunnel, retrocondylar groove, pronator teres and spiral groove as well as different areas that may entrap the plexus. Neuropathy at the area of the brachial plexus is called a plexopathy.

Peripheral neuropathies basically can have different levels of severity and can involve axonal damage and or myelin damage as well.

Peripheral neuropathies can be either poly or mono in nature, meaning involving one nerve such as a case of an isolated entrapment (Carpal tunnel) or can involve many (diabetic polyneuropathy).

Polyneuropathies can be a s result of multiple entrapments or systemic illness such as diabetes, guillain barre, hypothyroidism, liver disease, b12 deficiency, AIDS, leprosy, diptheria, sarcoidosis, sepsis or can be as a result of vascular or collagen disease as well as neoplastic disease and can also be drug induced, toxic, hereditary and metabolic.

The term radiculopathy is still encompassed by the general term of neuropathy, but is more specific now in regards to the type of neuropathy and that is nerve damage related the area of the nerve root.

This is a common place of injury and can be as a result of disk injury, spondylytic (arthritic) changes causing neural or central canal stenosis or other growths that are considered space occupying lesions such as neoplastic disease.

So basically the term neuropathy is a general term meaning disease process of a nerve and the other terms are just adjectives that give more meaning and understanding to the type of neuropathy present. Is it in one nerve and peripheral, is it in many nerves, is it in the plexus or is it at the level of the root?

All these are important to understand when determining the appropriate diagnosis of a patient!

The term myelopathy means disease process of the spinal cord and is usually associated with signs of upper motor neuron damage, unlike a peripheral neuropathy which is accompanied with signs of a lower motor lesion.

These can be compressive, ischemic, demyelinative, inflammatory and traumatic in etiology.
In conclusion it is important to do a good exam and isolate if the patients problem is a myelopathic (Cord) or neuropathic (Peripheral) disorder and then determine the type and the longitudinal level of the lesion with a good exam and history.

Then electrodiagnostic testing will help prove or disprove your clinical diagnosis which is then further used for better clinical application, understanding and treatment of the patient.

The exam, electrodiagnostics, advanced imaging and patient history as well as response to treatment offered are used when necessary as the basis for a patients clinical picture an diagnosis and are used to determine prognosis.


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