NERVE IMPINGEMENT

NERVE IMPINGEMENT

In this text, the term impingement is used to refer to nerve irritation associated with muscles. During the 1930s there was a great reluctance to talk about the possibility that, in addition to bones and other solid structures, muscles could play a role in irritating the nerves. In a 1934 article on the piriformis muscle, Albert H. Freiberg stated that "the pressure of a muscular belly on the sciatic nerve trunk can produce pain and tenderness [but] must be considered unproven at the moment." Freiberg was cautious and almost apologized for suggesting that the muscle could play that kind of role. In the same period, one of the original authors of

Muscles: Test and Function, Henry O. Kendall, boldly enough offered such explanations for various clinical entities. Most of the cases were related to muscles perforated by a peripheral nerve and in which movement and altered muscle length were factors that caused friction-type irritation on the nerve. Symptoms

Pain or discomfort can be caused by stretching the muscle, actively contracting the muscle, or repetitive movements. The authors are aware that the explanation of peripheral nerve pain on the basis of muscle pressure or friction remains a controversial issue with respect to some syndromes, most notably piriformis. However, the concept is well recognized with regards to nerve involvement in numerous muscles.

Under normal conditions and with normal range of motion, it can be assumed that a muscle is not causing irritation to a nerve in its immediate vicinity or perforating it. However, a tense muscle becomes firm and has the potential to exert a compressive or frictional force. A muscle that has developed adaptive shortening moves through a smaller interval and stiffens before reaching normal length; a stretched muscle moves more than normal before becoming tense. A strained muscle, especially a weight-bearing muscle, can cause friction on a nerve during repetitive movements. In mild cases, symptoms may be discomfort and dull pain rather than sharp pain when muscles contract or they are elongated. Sharp pain can be caused by vigorous movement, but tends to be intermittent as the person finds ways to avoid painful movements. Recognizing this phenomenon in the early stages can increase the likelihood of counteracting or preventing more painful or disabling problems that develop later. Physiotherapists who perform stretching and strengthening exercises have the opportunity to observe the first signs of conflict between their patients. The axillary nerve emerges through the quadrilateral space bounded by the great teres, the teres minor, the long head of the triceps and the humerus. When a teres major is stretched, a patient may complain of excruciating pain in the cutaneous sensory range of the axillary nerve. The assumption is that the axillary nerve is compressed or stretched against the tense teres major. The pain that comes from direct nerve irritation contrasts with the discomfort often associated with the habitual stretching of contracted muscles. The femoral nerve runs through the psoas major muscle. During assisted stretching exercises, a patient with The iliopsoas muscles may complain of pain along the anteromedial aspect of the leg in the cutaneous sensory range of the saphenous nerve. The greater occipital nerve perforates the trapezius muscle and fascia. Movements of the head and neck in the direction of contraction or lengthening of the trapezius can cause pain in the area of ​​the back of the head and in the cervical region.

Also note the following:

Supinator with radial nerve.

Pronator with median nerve.

Flexor carpus ulnar with ulnar nerve. Lateral head of the triceps with radial nerve.

Trapezius with greater occipital nerve.

Scalenus medius with root C5 and C6 del

Long thoracic plexus and nerve.

Coracobrachialis with musculocutaneous nerve.

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