Peripheral Neuropathy

Peripheral neuropathy is a term used to describe disorders of the peripheral nervous system. The peripheral nervous system includes nerves in the face, arms, legs, torso, and some nerves in the skull. In fact, all nerves not located in the central nervous system (which includes the brain and the spinal cord) are peripheral nerves.1

Peripheral neuropathy can be broadly categorized by the type of nerve that has been damaged. The peripheral nervous system is made up of three types of nerves: 2

  • Motor nerves – (responsible for voluntary movement).
  • Sensory nerves – (responsible for sensing temperature, pain, touch, and limb positioning).
  • Autonomic nerve – (responsible for involuntary functions such as breathing, blood pressure, sexual function, digestion).

Radiculopathy is the term for neuropathy that affects nerve roots. The nerve roots are extensions of spinal nerves. They exit the spinal canal through a space between vertebrae, called the neural foramen.2

Narrowing of the spinal column (spinal stenosis) from tumor, or a tumor can compress nerve roots and cause neuropathy.3

Movement Difficulties

Damage to the motor fibers interferes with muscle control and can cause weakness, loss of muscle bulk, and loss of dexterity. Sometimes, cramps are a sign of motor nerve involvement.4

Other muscle-related symptoms include: 5

  • Lack of muscle control
  • Difficulty or inability to move a part of the body (paralysis)
  • Muscle atrophy
  • Muscle twitching (fasciculation) or cramping
  • Difficulty breathing or swallowing
  • Falling (from legs buckling or tripping over toes)
  • Lack of dexterity (such as being unable to button a shirt)

Autonomic Symptoms

The autonomic nerves control involuntary or semi-voluntary functions, such as control of internal organs and blood pressure. Damage to autonomic nerves can cause: 5

  • Blurred vision.
  • Decreased ability to sweat.
  • Dizziness that occurs when standing up or fainting associated with a fall in blood pressure.
  • Heat intolerance with exertion (decreased ability to regulate body temperature).
  • Nausea or vomiting after meals.
  • Abdominal bloating (swelling).
  • Feeling full after eating a small amount (early satiety).
  • Diarrhea.
  • Constipation.
  • Unintentional weight loss (more than 5% of body weight).
  • Urinary incontinence.
  • Feeling of incomplete bladder emptying.
  • Difficulty beginning to urinate (urinary hesitancy).
  • Male impotence.

Treatment of Neuropathy

Following a thorough evaluation by a physical therapist a specific treatment program is designed in combination with the goals of the patient. Treatment goals include decreased pain, increased sensation, increased strength, range of movement (ROM) and improved balance for safe walking. Decreased pain and improved sensation are addressed through the use of Infrared light therapy. Research has shown infrared light increases the release of nitric oxide which improves circulation, increases sensation and promotes tissue healing.

Electrical stimulation which works to re-polarize and re-educate the nerves. Once the sensation improves and pain diminishes the patient is able to progress with strengthening and balance exercises enabling the patient to have an improved quality of life.

Tests that reveal neuropathy may include: 5

  • Electromyography (EMG – a recording of electrical activity in muscles). Health Encylopaedia, Penn Medicine.
  • Nerve conduction velocity (NCV – a test to see how fast electrical signals move through a nerve). Health Encylopaedia, Penn Medicine.
  • Nerve biopsy – the removal of a small piece of a nerve for examination. Health Encylopaedia, Penn Medicine.
  • Blood tests to screen for medical conditions, such as diabetes and vitamin deficiency, among others.

Interactive spine nerve charts:

References

1 Peripheral Neuropathy – Mayo Clinic.

2 Neuropathy.

3 General Neurological Definitions – University of Pittsburgh.

4 Peripheral Neuropathy – U.S. National Library of Medicine.

5 Peripheral neuropathy – Health Encylopaedia, Penn Medicine.

Further Readings: