ALT EKSTREMİTELERİN TUZAK NÖROPATİLERİ

Alt ekstremite periferik sinirleri, traseleri boyunca anatomik olarak duyarlı bulundukları bölgelerde sıkışabilir. Siniri direkt olarak etkileyen herhangi bir travma veya sinir çevresindeki bir inflamatuar durum da nöropatiye neden olabilir. Hem etyolojinin, hem de klinik semptom ve bulguların çok çeşitli olabilmesi, klinisyenin tanıda zorluklarla karşılaşmasına neden olabilir. Bir periferik nöropatinin ana semptomu parestezidir; buna sıkışma şiddetinin derecesine bağlı olarak ağrı ve hissizlik eşlik edebilir. Alt ekstremitelerin innervasyonu L1-S3 köklerinin anterior ramuslarından oluşan lumbosakral pleksus tarafından sağlanır. Sinirlerin zedelenmeye daha duyarlı olduğu belirli anatomik bölgeler vardır. Hasar bölgesini saptamak ve uygun tedaviyi planlamak için lumbosakral pleksustan çıkan her sinirin motor ve duyu dağılımının net olarak ayırt edilmesi önemlidir. Lezyon bölgesinin saptanması, lezyonun şiddeti ve iyileşme potansiyeli ile ilgili ipuçları vermesi, pleksopati/radikülopati ayrımının yapılabilmesi açısından elektrodiagnostik çalışmalar oldukça faydalıdır. Görüntüleme yöntemlerinden özellikle manyetik rezonans görüntüleme, tuzak nöropatisi tanısının desteklenmesi veya diğer patolojilerin ekarte edilmesi için istenebilir. Tuzak nöropatilerin hepsi değilse de çoğu konservatif olarak tedavi edilebilmektedir. Bu derlemede alt ekstremitelerde sıkça görülen nöropatiler olan meralgia parestetika, femoral, obturator, siyatik, peroneal ve tibial nöropatilerden bahsedilecektir

Entrapment Neuropathies of The Lower Extremities

Peripheral nerves of the lower extremities might be compressed on their course where the anatomic configuration puts them in a vulnerable position. Neuropathic states can also be the result of any kind of trauma which directly injures the nerves or leads to a state of inflammation around the nerves. A wide variety of etiologies, as well as clinical presentations, may lead to diagnostic challenges for the clinician. The main symptom of a peripheral neuropathy is paresthesia. This could be accompanied by pain and numbness depending on the severity of the compression. The lumbosacral plexus, which arises from the ventral rami of the L1-S3 roots, serves the lower extremities. There are particular anatomic sites where the nerves are more vulnerable. A clear identification of the anatomic course, and motor and sensory distribution of each nerve arising from the lumbosacral plexus, is critical in localizing the injury and planning the optimal treatment. Electrodiagnostic studies help localize the site of the lesion, give a clue about the severity and potential recovery, and help differentiate any plexopathy and/or radiculopathy. Imaging studies, mostly magnetic imaging, can be ordered to help confirm the entrapment or exclude other pathologies. Most, but not all, of the cases can be treated by conservative measures. Common entrapments of the lower extremities, namely, meralgia paresthetica, femoral, obturator, sciatic, peroneal and tibial neuropathies will be discussed in this review

Keywords:

neuropathy, lower extremity entrapment,

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