What is mononeuropathy

Mononeuropathy or focal neuropathy is damage to a single nerve, which results in loss of movement, sensation, or other function of that nerve. Mononeuropathy is a type of damage to a nerve outside the brain and spinal cord (peripheral neuropathy). Mononeuropathy is most often caused by injury. Diseases affecting the entire body (systemic disorders) can also cause isolated nerve damage.

Long-term pressure on a nerve due to swelling or injury can result in mononeuropathy. The covering of the nerve (myelin sheath) or part of the nerve cell (the axon) may be damaged. This damage slows or prevents signals from traveling through the damaged nerves. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes. It can cause numbness or tingling in your hand or fingers, except your pinkie (little finger). Your hand may feel weak, and you may drop things.

Mononeuropathy may be disabling and painful. If the cause of the nerve dysfunction can be found and successfully treated, a full recovery is possible in some cases. Nerve pain may be uncomfortable and last for a long time.

Mononeuropathy may involve any part of the body. Some common forms of mononeuropathy include:

• Axillary nerve dysfunction (loss of movement or sensation in the shoulder)
• Common peroneal nerve dysfunction (loss of movement or sensation in the foot and leg)
• Carpal tunnel syndrome (median nerve dysfunction — including numbness, tingling, weakness, or muscle damage in the hand and fingers)
• Cranial mononeuropathy III, IV, compression or diabetic type
• Cranial mononeuropathy VI (double vision)
• Cranial mononeuropathy VII (facial paralysis)
• Femoral nerve dysfunction (loss of movement or sensation in part of the leg)
• Radial nerve dysfunction (problems with movement in the arm and wrist and with sensation in the back of the arm or hand)
• Sciatic nerve dysfunction (problem with the muscles of the back of the knee and lower leg, and sensation to the back of the thigh, part of the lower leg, and sole of the foot)
• Ulnar nerve dysfunction (cubital tunnel syndrome — including numbness, tingling, weakness of outer and underside of arm, palm, ring and little fingers)

Mononeuropathy vs Polyneuropathy

Sensorimotor polyneuropathy is a bodywide (systemic) process that damages nerve cells, nerve fibers (axons), and nerve coverings (myelin sheath). Damage to the covering of the nerve cell causes nerve signals to slow or stop. Damage to the nerve fiber or entire nerve cell can make the nerve stop working. Some neuropathies develop over years, while others can start and get severe within hours to days. Sensorimotor polyneuropathy is a condition that causes a decreased ability to move or feel (sensation) because of nerve damage.

Nerve damage can be caused by:

• Autoimmune (when the body attacks itself) disorders
• Conditions that put pressure on nerves
• Decreased blood flow to the nerve
• Diseases that destroy the glue (connective tissue) that holds cells and tissues together
• Swelling (inflammation) of the nerves

Some diseases lead to polyneuropathy that is mainly sensory or mainly motor. Possible causes of sensorimotor polyneuropathy include:

• Alcoholic neuropathy
• Amyloid polyneuropathy
• Autoimmune disorders, such as Sjögren syndrome
• Cancer (called a paraneoplastic neuropathy)
• Long-term (chronic) inflammatory neuropathy
• Diabetic neuropathy
• Drug-related neuropathy, including chemotherapy
• Guillain-Barré syndrome
• Hereditary neuropathy
• HIV/AIDS
• Low thyroid
• Parkinson disease
• Vitamin deficiency (vitamins B12, B1, and E)
• Zika virus infection

Polyneuropathy symptoms may include any of the following:

• Decreased feeling in any area of the body
• Difficulty swallowing or breathing
• Difficulty using the arms or hands
• Difficulty using the legs or feet
• Difficulty walking
• Pain, burning, tingling, or abnormal feeling in any area of the body (called neuralgia)
• Weakness of the face, arms, or legs, or any area of the body

Symptoms may develop quickly (as in Guillain-Barré syndrome) or slowly over weeks to years. Symptoms usually occur on both sides of the body. Most often, they start at the ends of the toes first.

Polyneuropathy treatment

Goals of polyneuropathy treatment include:

• Finding the cause
• Controlling the symptoms
• Promoting a person’s self-care and independence

Depending on the cause, treatment may include:

• Changing medicines, if they are causing the problem
• Controlling blood sugar level, when the neuropathy is from diabetes
• Not drinking alcohol
• Taking daily nutritional supplements
• Medicines to treat the underlying cause of the polyneuropathy

Self-care

• Exercises and retraining to maximize function of the damaged nerves
• Job (vocational) therapy
• Occupational therapy
• Orthopedic treatments
• Physical therapy
• Wheelchairs, braces, or splints

Control of symptoms

Safety is important for people with neuropathy. Lack of muscle control and decreased sensation can increase the risk of falls or other injuries.

If you have movement difficulties, these measures can help keep you safe:

• Leave lights on.
• Remove obstacles (such as loose rugs that may slip on the floor).
• Test water temperature before bathing.
• Use railings.
• Wear protective shoes (such as those with closed toes and low heels).
• Wear shoes that have non-slippery soles.

Other tips include:

• Check your feet (or other affected area) daily for bruises, open skin areas, or other injuries, which you may not notice and can become infected.
• Check the inside of shoes often for grit or rough spots that may injure your feet.
• Visit a foot doctor (podiatrist) to assess and reduce the risk of injury to your feet.
• Avoid leaning on your elbows, crossing your knees, or being in other positions that put prolonged pressure on certain body areas.

Medicines used to treat this condition:

• Over-the-counter and prescription pain relievers to reduce stabbing pain (neuralgia)
• Anticonvulsants or antidepressants
• Lotions, creams, or medicated patches

Use pain medicine only when necessary. Keeping your body in the proper position or keeping bed linens off a tender body part may help control pain.

Diabetic mononeuropathy

Diabetic mononeuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerves throughout your body. Diabetic mononeuropathy most often damages nerves in your legs and feet.

Depending on the affected nerves, symptoms of diabetic mononeuropathy can range from pain and numbness in your legs and feet to problems with your digestive system, urinary tract, blood vessels and heart. Some people have mild symptoms. But for others, diabetic mononeuropathy can be quite painful and disabling.

Diabetic mononeuropathy is a common and serious complication of diabetes. But you can often prevent diabetic mononeuropathy or slow its progress with tight blood sugar control and a healthy lifestyle.

Diabetic mononeuropathy often occur in the older population; diabetic mononeuropathies have an acute onset, are associated with pain, and have a self-limiting course resolving in 6–8 weeks ¹⁾. Diabetic mononeuropathy can involve the median (5.8% of all diabetic neuropathies), ulnar (2.1%), radial (0.6%), and common peroneal nerves ²⁾. Cranial neuropathies in diabetic patients are extremely rare (0.05%) and occur in older individuals with a long duration of diabetes ³⁾. Entrapment syndromes start slowly, and will progress and persist without intervention. Carpal tunnel syndrome occurs three times as frequently in diabetics compared with healthy populations ⁴⁾ and is found in up to one third of patients with diabetes. Its increased prevalence in diabetes may be related to repeated undetected trauma, metabolic changes, or accumulation of fluid or edema within the confined space of the carpal tunnel ⁵⁾.

Diabetic mononeuropathy causes

Researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals, leading to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.

However, a combination of factors may lead to nerve damage, including:

• Inflammation in the nerves caused by an autoimmune response. The immune system mistakes nerves as foreign and attacks them.
• Genetic factors unrelated to diabetes may make some people more likely to develop nerve damage.
• Smoking and alcohol abuse damage both nerves and blood vessels and significantly increase the risk of infection.

Risk factors for developing diabetic mononeuropathy

Anyone who has diabetes can develop neuropathy, but these risk factors make you more likely to get nerve damage:

• Poor blood sugar control. Uncontrolled blood sugar puts you at risk of every diabetes complication, including nerve damage.
• Diabetes history. Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar isn’t well-controlled.
• Kidney disease. Diabetes can damage the kidneys. Kidney damage sends toxins into the blood, which can lead to nerve damage.
• Being overweight. Having a body mass index (BMI) greater than 24 may increase your risk of diabetic neuropathy.
• Smoking. Smoking narrows and hardens your arteries, reducing blood flow to your legs and feet. This makes it more difficult for wounds to heal and damages the peripheral nerves.

Diabetic mononeuropathy prevention

You can prevent or delay diabetic neuropathy and its complications by keeping tight control of your blood sugar and taking good care of your feet.

Blood sugar control

Use an at-home blood sugar monitor to check your blood sugar and make sure it consistently stays within target range. It’s important to do this on schedule. Shifts in blood sugar levels can accelerate nerve damage.

The American Diabetes Association recommends that people with diabetes have the A1C test at least twice a year. This blood test indicates your average blood sugar level for the past two to three months. If your blood sugar isn’t well-controlled or you change medications, you may need to get tested more often.

Foot care

Follow your doctor’s recommendations for good foot care.

Foot problems, including sores that don’t heal, ulcers and even amputation, are a common complication of diabetic neuropathy. But you can prevent many of these problems by having a comprehensive foot exam at least once a year, having your doctor check your feet at each office visit and taking good care of your feet at home.

To protect the health of your feet:

• Check your feet every day. Look for blisters, cuts, bruises, cracked and peeling skin, redness, and swelling. Use a mirror or ask a friend or family member to help examine parts of your feet that are hard to see.
• Keep your feet clean and dry. Wash your feet every day with lukewarm water and mild soap. Avoid soaking your feet. Dry your feet and between your toes carefully by blotting or patting with a soft towel. Moisturize your feet thoroughly to prevent cracking. Avoid getting lotion between your toes, however, as this can encourage fungal growth.
• Trim your toenails carefully. Cut your toenails straight across, and file the edges carefully so there are no sharp edges.
  Wear clean, dry socks. Look for socks made of cotton or moisture-wicking fibers that don’t have tight bands or thick seams.
• Wear cushioned shoes that fit well. Always wear shoes or slippers to protect your feet from injury. Make sure that your shoes fit properly and allow your toes to move. A podiatrist (foot doctor) can teach you how to buy properly fitted shoes and to prevent problems such as corns and calluses. If problems do occur, your doctor can help treat them to prevent more-serious conditions. Even small sores can quickly turn into severe infections if left untreated. If you qualify for Medicare, your plan may cover the cost of at least one pair of shoes each year. Talk to your doctor or diabetes educator for more information.

Diabetic mononeuropathy complications

Diabetic neuropathy can cause a number of serious complications, including:

• Loss of a toe, foot or leg. Nerve damage can make you lose feeling in your feet. Foot sores and cuts may silently become severely infected or turn into ulcers. Even minor foot sores that don’t heal can turn into ulcers. In severe cases, infection can spread to the bone, and ulcers can lead to tissue death (gangrene). Removal (amputation) of a toe, foot or even the lower leg may be necessary.
• Joint damage. Nerve damage can cause a joint to deteriorate, causing a condition called Charcot joint. This usually occurs in the small joints in the feet. Symptoms include loss of sensation and joint swelling, instability and sometimes joint deformity. Prompt treatment can help you heal and prevent further joint damage.
• Urinary tract infections and urinary incontinence. If the nerves that control your bladder are damaged, you may be unable to fully empty your bladder. Bacteria can build up in the bladder and kidneys, causing urinary tract infections. Nerve damage can also affect your ability to feel when you need to urinate or to control the muscles that release urine, leading to leakage (incontinence).
• Hypoglycemia unawareness. Low blood sugar (below 70 milligrams per deciliter, or mg/dL) normally causes shakiness, sweating and a fast heartbeat. But if you have autonomic neuropathy, you may not notice these warning signs.
• Sharp drops in blood pressure. Damage to the nerves that control blood flow can affect your body’s ability to adjust blood pressure. This can cause a sharp drop in pressure when you stand after sitting (orthostatic hypotension), which may lead to dizziness and fainting.
• Digestive problems. If nerve damage strikes your digestive tract, you can have constipation or diarrhea, or bouts of both. Diabetes-related nerve damage can lead to gastroparesis, a condition in which the stomach empties too slowly or not at all. This can interfere with digestion and severely affect blood sugar levels and nutrition. Signs and symptoms include nausea, vomiting and bloating.
• Sexual dysfunction. Autonomic neuropathy often damages the nerves that affect the sex organs. Men may experience erectile dysfunction. Women may have difficulty with lubrication and arousal.
• Increased or decreased sweating. Nerve damage can disrupt how your sweat glands work and make it difficult for your body to control its temperature properly. Some people with autonomic neuropathy have excessive sweating, particularly at night or while eating. Too little or no sweating at all (anhidrosis) can be life-threatening.

Diabetic mononeuropathy diagnosis

A doctor can usually diagnose diabetic neuropathy by performing a physical exam and carefully reviewing your symptoms and medical history.

Your doctor will check your:

• Overall muscle strength and tone
• Tendon reflexes
• Sensitivity to touch and vibration

Also at every visit, your doctor should check your feet for sores, cracked skin, blisters, and bone and joint problems. The American Diabetes Association recommends that all people with diabetes have a comprehensive foot exam at least once a year.

Along with the physical exam, your doctor may perform or order specific tests to help diagnose diabetic neuropathy, such as:

• Filament test. Your doctor will brush a soft nylon fiber (monofilament) over areas of your skin to test your sensitivity to touch.
• Quantitative sensory testing. This noninvasive test is used to tell how your nerves respond to vibration and changes in temperature.
• Nerve conduction studies. This test measures how quickly the nerves in your arms and legs conduct electrical signals. It’s often used to diagnose carpal tunnel syndrome.
• Electromyography (EMG). Often performed along with nerve conduction studies, EMG measures the electrical discharges produced in your muscles.
• Autonomic testing. If you have symptoms of autonomic neuropathy, special tests may be done to determine how your blood pressure changes while you are in different positions, and whether you sweat normally.

Diabetic mononeuropathy treatment

Diabetic neuropathy has no known cure. The goals of treatment are to:

• Slow progression of the disease
• Relieve pain
• Manage complications and restore function

Slowing progression of the disease

Consistently keeping your blood sugar within your target range is the key to preventing or delaying nerve damage. Doing so may even improve some of your current symptoms. Your doctor will determine the best target range for you based on several factors, such as your age, how long you’ve had diabetes and your overall health.

For many people who have diabetes, the American Diabetes Association generally recommends the following target blood sugar levels:

• Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals
• Less than 180 mg/dL (10.0 mmol/L) two hours after meals

For many people who have diabetes, Mayo Clinic generally recommends the following target blood sugar levels before meals:

• Between 80 and 120 mg/dL (4.4 and 6.7 mmol/L) for people age 59 and younger who have no other medical conditions
• Between 100 and 140 mg/dL (5.6 and 7.8 mmol/L) for people age 60 and older, or for those who have other medical conditions, including heart, lung or kidney disease

Keep in mind, your doctor may need to adjust these target ranges to meet your individual health needs.

Other important ways to help slow or prevent disease progression include keeping your blood pressure under control and maintaining a healthy weight and lifestyle.

Relieving pain

Many prescription medications are available for diabetes-related nerve pain, but they don’t work for everyone. Side effects are always possible. When considering any medication, talk to your doctor about the benefits and drawbacks to determine what might work best for you.

Pain-relieving prescription treatments may include:

• Anti-seizure drugs. Some medications used to treat seizure disorders (epilepsy) are also used to ease nerve pain. The American Diabetes Association recommends starting with pregabalin (Lyrica). Others that have been used to treat neuropathy are gabapentin (Gralise, Neurontin) and carbamazepine (Carbatrol, Tegretol). Side effects may include drowsiness, dizziness and swelling.
• Antidepressants. Some antidepressants disrupt the chemical processes in the brain that make you feel pain. You don’t need to have depression for these medicines to ease nerve pain. Two classes of antidepressants have been used for neuropathy treatment.
  • Tricyclic antidepressants, including amitriptyline, desipramine (Norpramin) and imipramine (Tofranil), may provide relief for mild to moderate symptoms. But side effects can be bothersome and include dry mouth, sweating, weight gain, constipation and dizziness.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) may ease pain with fewer side effects. The American Diabetes Association recommends duloxetine (Cymbalta) as a first treatment. Another that may be used is venlafaxine (Effexor XR). Possible side effects of SNRIs include nausea, sleepiness, dizziness, decreased appetite and constipation.

Sometimes, an antidepressant may be combined with an anti-seizure drug or pain-relieving medication.

Managing complications and restoring function

Your diabetes health care team will likely include different specialists, such as doctor that treats urinary tract problems (urologist) and a heart doctor (cardiologist), who can help prevent or treat complications.

Treatment depends on the neuropathy-related complication you have:

• Urinary tract problems. Some medications can interfere with bladder function. Your doctor may recommend stopping or changing medications. A strict urination schedule or urinating every few hours (timed urination) while applying gentle pressure to the bladder area (below your bellybutton) is recommended. Other methods, including self-catheterization, may be needed to remove urine from a nerve-damaged bladder.
• Digestive problems. To relieve mild signs and symptoms of gastroparesis — indigestion, belching, nausea or vomiting — doctors suggest eating smaller, more-frequent meals, reducing fiber and fat in the diet, and, for many people, eating soups and pureed foods. Diet changes and medications may help relieve diarrhea, constipation and nausea.
• Low blood pressure on standing (orthostatic hypotension). Treatment starts with simple lifestyle changes, such as avoiding alcohol, drinking plenty of water, and sitting or standing slowly. Sleeping with the head of the bed raised 6 to 10 inches helps prevent swings in blood pressure. Your doctor may also recommend compression stockings and similar compression support for your abdomen (abdominal binder). Several medications, either alone or together, may be used to treat orthostatic hypotension.
• Sexual dysfunction. Medications taken by mouth or injection may improve sexual function in some men, but they aren’t safe and effective for everyone. Mechanical vacuum devices may increase blood flow to the penis. Women may find relief with vaginal lubricants.

Multiple mononeuropathy

Multiple mononeuropathy is a nervous system disorder that involves damage to at least two separate nerve areas. Multiple mononeuropathy is a form of damage to one or more peripheral nerves. These are the nerves outside the brain and spinal cord. It is a group of symptoms (syndrome), not a disease.

However, certain diseases can cause the injury or nerve damage that leads to the symptoms of multiple mononeuropathy. Common conditions include:

• Blood vessel diseases such as polyarteritis nodosa
• Connective tissue diseases such as rheumatoid arthritis or systemic lupus erythematosus (the most common cause in children)
• Diabetes

Less common causes include:

• Amyloidosis, an abnormal buildup of proteins in tissues and organs
• Blood disorders (such as hypereosinophilia and cryoglobulinemia)
• Infections such as Lyme disease, HIV/AIDS, or hepatitis
• Leprosy
• Sarcoidosis, inflammation of the lymph nodes, lungs, liver, eyes, skin, or other tissues
• Sjögren syndrome, a disorder in which the glands that produce tears and saliva are destroyed
• Granulomatosis with polyangiitis, an inflammation of the blood vessel

Multiple mononeuropathy symptoms

Symptoms depend on the specific nerves involved, and may include:

• Loss of bladder or bowel control
• Loss of sensation in one or more areas of the body
• Paralysis in one or more areas of the body
• Tingling, burning, pain, or other abnormal sensations in one or more areas of the body
• Weakness in one or more areas of the body

Multiple mononeuropathy possible complications

Multiple mononeuropathy complications may include:

• Deformity, loss of tissue or muscle mass
• Disturbances of organ functions
• Medicine side effects
• Repeated or unnoticed injury to the affected area due to lack of sensation
• Relationship problems due to erectile dysfunction

Multiple mononeuropathy diagnosis

Your health care provider will perform a physical exam and ask about the symptoms, focusing on the nervous system.

To diagnose this syndrome, there usually needs to be problems with 2 or more unrelated nerve areas. Common nerves affected are the:

• Axillary nerve in either arm and shoulder
• Common peroneal nerve in the lower leg
• Distal median nerve to the hand
• Femoral nerve in the thigh
• Radial nerve in the arm
• Sciatic nerve in the back of the leg
• Ulnar nerve in the arm

Tests may include:

• Electromyogram (EMG, a recording of electrical activity in the muscles)
• Nerve biopsy to examine a piece of the nerve under a microscope
• Nerve conduction tests to measure how fast nerve impulses move along the nerve
• Imaging tests, such as x-rays

Blood tests that may be done include:

• Antinuclear antibody panel (ANA)
• Blood chemistry tests
• C-reactive protein
• Imaging scans
• Pregnancy test
• Rheumatoid factor
• Sedimentation rate
• Thyroid tests
• X-rays

Multiple mononeuropathy treatment

The goals of treatment are to:

• Treat the illness that is causing the problem, if possible
• Provide supportive care to maintain independence
• Control symptoms

To improve independence, treatments may include:

• Occupational therapy
• Orthopedic help (for example, a wheelchair, braces, and splints)
• Physical therapy (for example, exercises and retraining to increase muscle strength)
• Vocational therapy

Safety is an important for people with sensation or movement problems. Lack of muscle control and decreased sensation may increase the risk for falls or injuries. Safety measures include:

• Having adequate lighting (such as leaving lights on at night)
• Installing railings
• Removing obstacles (such as loose rugs that may slip on the floor)
• Testing water temperature before bathing
• Wearing protective shoes (no open toes or high heels)

Check shoes often for grit or rough spots that may injure the feet.

People with decreased sensation should check their feet (or other affected area) often for bruises, open skin areas, or other injuries that may go unnoticed. These injuries may become severely infected because the pain nerves of the area are not signaling the injury.

People with multiple mononeuropathy are prone to new nerve injuries at pressure points such as the knees and elbows. They should avoid putting pressure on these areas, for example, by not leaning on the elbows, crossing the knees, or holding similar positions for long periods.

Medicines that may help include:

• Over-the-counter or prescription pain drugs
• Antiseizure or antidepressant drugs to reduce stabbing pains

Multiple mononeuropathy prognosis

A full recovery is possible if the cause is found and treated, and if the nerve damage is limited. Some people have no disability. Others have a partial or complete loss of movement, function, or sensation.

Peroneal mononeuropathy

Common peroneal mononeuropathy is damage to the peroneal nerve leading to loss of movement or sensation in the foot and leg. The peroneal nerve is a branch of the sciatic nerve, which supplies movement and sensation to the lower leg, foot and toes. Common peroneal mononeuropathy is a type of peripheral neuropathy (damage to nerves outside the brain or spinal cord). This condition can affect people of any age.

Dysfunction of a single nerve, such as the common peroneal nerve, is called a mononeuropathy. Mononeuropathy means the nerve damage occurred in one area. Certain body-wide conditions can also cause single nerve injuries.

Damage to the nerve disrupts the myelin sheath that covers the axon (branch of the nerve cell). The axon can also be injured, which causes more severe symptoms.

Common causes of damage to the peroneal nerve include the following:

• Trauma or injury to the knee
• Fracture of the fibula (a bone of the lower leg)
• Use of a tight plaster cast (or other long-term constriction) of the lower leg
• Crossing the legs regularly
• Regularly wearing high boots
• Pressure to the knee from positions during deep sleep or coma
• Injury during knee surgery or from being placed in an awkward position during anesthesia

Common peroneal nerve injury is often seen in people:

• Who are very thin (for example, from anorexia nervosa)
• Who have certain autoimmune conditions, such as polyarteritis nodosa
• Who have nerve damage from other medical problems, such as diabetes or alcohol use
• Who have Charcot-Marie-Tooth disease, an inherited disorder that affects all of the nerves

Peroneal mononeuropathy prevention

Avoid crossing your legs or putting long-term pressure on the back or side of the knee. Treat injuries to the leg or knee right away.

If a cast, splint, dressing, or other pressure on the lower leg causes a tight feeling or numbness, call your provider.

Peroneal mononeuropathy symptoms

When the nerve is injured and results in dysfunction, symptoms may include:

• Decreased sensation, numbness, or tingling in the top of the foot or the outer part of the upper or lower leg
• Foot that drops (unable to hold the foot up)
• “Slapping” gait (walking pattern in which each step makes a slapping noise)
• Toes drag while walking
• Walking problems
• Weakness of the ankles or feet
• Loss of muscle mass because the nerves aren’t stimulating the muscles

Peroneal mononeuropathy complications

Problems that may develop with peroneal mononeuropathy include:

• Decreased ability to walk
• Permanent decrease in sensation in the legs or feet
• Permanent weakness or paralysis in the legs or feet
• Side effects of medicines

Peroneal mononeuropathy diagnosis

Your health care provider will perform a physical exam, which may show:

• Loss of muscle control in the lower legs and feet
• Atrophy of the foot or foreleg muscles
• Difficulty lifting up the foot and toes and making toe-out movements

Tests of peroneal nerve activity include:

• Electromyography (EMG, a test of electrical activity in muscles)
• Nerve conduction tests (to see how fast electrical signals move through a nerve)
• MRI
• Nerve ultrasound

Other tests may be done depending on the suspected cause of nerve dysfunction, and the person’s symptoms and how they develop. Tests may include blood tests, x-rays and scans.

Peroneal mononeuropathy treatment

Treatment aims to improve mobility and independence. Any illness or other cause of the peroneal mononeuropathy should be treated. Padding the knee may prevent further injury by crossing the legs, while also serving as a reminder to not cross your legs.

In some cases, corticosteroids injected into the area may reduce swelling and pressure on the nerve.

You may need surgery if:

• The peroneal mononeuropathy does not go away
• You have problems with movement
• There is evidence that the nerve axon is damaged

Surgery to relieve pressure on the peroneal nerve may reduce symptoms if the peroneal mononeuropathy is caused by pressure on the nerve. Surgery to remove tumors on the peroneal nerve may also help.

Controlling symptoms

You may need over-the-counter or prescription pain relievers to control pain. Other medicines that may be used to reduce pain include gabapentin, carbamazepine, or tricyclic antidepressants, such as amitriptyline.

If your pain is severe, a pain specialist can help you explore all options for pain relief.

Physical therapy exercises may help you maintain muscle strength.

Orthopedic devices may improve your ability to walk and prevent contractures. These may include braces, splints, orthopedic shoes, or other equipment.

Vocational counseling, occupational therapy, or similar programs may help you maximize your mobility and independence.

Peroneal mononeuropathy prognosis

Outcome depends on the cause of the peroneal mononeuropathy. Successfully treating the cause may relieve the dysfunction, although it may take several months for the peroneal nerve to improve.

If nerve damage is severe, disability may be permanent. The nerve pain may be very uncomfortable. Peroneal mononeuropathy does not usually shorten a person’s expected lifespan.

Mononeuropathy prevention

Avoiding pressure or traumatic injury may prevent many forms of mononeuropathy. Treating conditions such as high blood pressure or diabetes also decreases the risk of developing the condition.

Mononeuropathy symptoms

Mononeuropathy symptoms depend on the specific nerve affected, and may include:

• Loss of sensation
• Paralysis
• Tingling, burning, pain, abnormal sensations
• Weakness

Mononeuropathy can cause damage to a specific nerve in the face, middle of the body (torso) or leg. It’s most common in older adults. Mononeuropathy often strikes suddenly and can cause severe pain.

Your specific signs and symptoms depend on which nerve is involved. You may have pain in the:

• Shin or foot
• Lower back or pelvis
• Front of thigh
• Chest or abdomen

Mononeuropathy may also cause nerve problems in the eyes and face, leading to:

• Difficulty focusing
• Double vision
• Aching behind one eye
• Paralysis on one side of your face (Bell’s palsy)

Mononeuropathy complications

Mononeuropathy complications may include:

• Deformity, loss of tissue mass
• Medicine side effects
• Repeated or unnoticed injury to the affected area due to lack of sensation

Mononeuropathy diagnosis

Your health care provider will perform a physical exam and focus on the affected area. A detailed medical history is needed to determine the possible cause of the disorder.

Tests that may be done include:

• Electromyogram (EMG) to check the electrical activity in the muscles
• Nerve conduction tests (NCV) to check the speed of electrical activity in the nerves
• Nerve ultrasound to view the nerves
• X-ray, MRI or CT scan to get an overall view of the affected area
• Blood tests
• Nerve biopsy (in case of mononeuropathy due to vasculitis)
• CSF examination
• Skin biopsy

Mononeuropathy treatment

The goal of treatment is to allow you to use the affected body part as much as possible.

Some medical conditions make nerves more prone to injury. For example, high blood pressure and diabetes can injure an artery, which can often affect a single nerve. So, the underlying condition should be treated.

Treatment options may include any of the following:

• Over the counter painkillers, such as anti-inflammatory medicines for mild pain
• Antidepressants, anticonvulsants, and similar medicines for chronic pain
• Injections of steroid medicines to reduce swelling and pressure on the nerve
• Surgery to relieve pressure on the nerve
• Physical therapy exercises to maintain muscle strength
• Braces, splints, or other devices to help with movement
• Transcutaneous electrical nerve stimulation (TENS) to improve nerve pain associated with diabetes