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Diagnostics
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Peripheral Neuropathy and Related Diseases: Symptoms, Diagnosis, and Treatment
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Peripheral Neuropathy and Related Diseases: Symptoms, Diagnosis, and Treatment

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 August 2024) | Viewed by 20061

Special Issue Editor

Dr. Federica Ginanneschi

E-Mail Website
Guest Editor
Neurology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
Interests: neurophysiology; carpal tunnel syndrome; clinical electrophysiology; hand surgery; neuromuscular disorders

Special Issue Information

Dear Colleagues,

Peripheral neuropathy, a result of damage to the nerves located outside of the brain and spinal cord (peripheral nerves), often causes weakness, numbness, and pain, usually in the hands and feet. It can also affect other areas and body functions including digestion, urination, and circulation. It can result from traumatic injuries, infections, metabolic problems, inherited causes, and exposure to toxins. One of the most common causes is diabetes.

Every nerve in your peripheral system has a specific function, so symptoms depend on the type of nerves affected. (sensory nerves, motor nerves, and autonomic nerves). Peripheral neuropathy can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy), or many nerves (polyneuropathy). Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy.

Several tests may be used to diagnose peripheral neuropathy and its underlying cause:

  • Blood tests;
  • Imaging tests;
  • Nerve function tests;
  • Other nerve function tests;
  • Nerve biopsy;
  • Skin biopsy.

Our Special Issue aims to collect research regarding all the aspects of peripheral neuropathy and related diseases (etiology, diagnosis, and treatment), to provide new advances to clinical medical practice.

Dr. Federica Ginanneschi
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • peripheral neuropathies
  • diagnosis
  • clinical electrophysiology
  • carpal tunnel syndrome
  • neuromuscular disorders

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Published Papers (5 papers)

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Research

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10 pages, 831 KiB  
Article
A Proposal for Neurography Referral in Patients with Carpal Tunnel Syndrome Based on Clinical Symptoms and Demographic Variables of 797 Patients
by Fernando Vázquez-Sánchez, Ana Isabel Gómez-Menéndez, María López-Veloso, Sara Calvo-Simal, María Carmen Lloria-Gil, Josefa González-Santos, María Nieves Muñoz-Alcaraz, Antonio José Jiménez-Vilchez, Jerónimo J. González-Bernal and Beatriz García-López
Diagnostics 2024, 14(3), 297; https://doi.org/10.3390/diagnostics14030297 - 30 Jan 2024
Cited by 1 | Viewed by 1641
Abstract
The clinical manifestation of median nerve entrapment at the carpal tunnel level is known as carpal tunnel syndrome (CTS). Electroneurography (ENG) is considered the gold standard in CTS evaluation. We conducted a retrospective study and analyzed some clinical and demographic variables, relating them [...] Read more.
The clinical manifestation of median nerve entrapment at the carpal tunnel level is known as carpal tunnel syndrome (CTS). Electroneurography (ENG) is considered the gold standard in CTS evaluation. We conducted a retrospective study and analyzed some clinical and demographic variables, relating them to the degree of neuropathy using ENG, to better understand the role of ENG in this very common disease. We studied 816 patients referred to our service for neurographic evaluation. Their symptoms were classified as compatible with CTS (cCTS) (n = 646) and atypical for CTS (aCTS) (n = 170). A blind ENG was performed on 797 patients. Patient characteristics were coded as variables and analyzed to study whether they could predict neuropathy severity (sensory and motor involvement or grade ≥ 3 in our classification). We found a correlation between typical symptomatology, age over 50 years, male gender, positivity of Phalen’s maneuver and Tinel’s sign, and a neuropathy grade ≥ 3. We also found a correlation with CTS in the contralateral hand if the other hand showed neuropathy, despite the lack of symptoms in this hand. We propose a practical algorithm for ENG referral based on clinical symptoms, demographic factors, and neurophysiological variables. Full article
(This article belongs to the Special Issue Peripheral Neuropathy and Related Diseases: Symptoms, Diagnosis, and Treatment)
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11 pages, 564 KiB  
Article
Increased Risk of Coronary Artery Disease in People with Diagnosis of Neuromuscular Disorders: A Nationwide Retrospective Population-Based Case–Control Study
by Yi-Chuan Chang, Ing-Shiow Lay, Cheng-Hao Tu and Yu-Chen Lee
Diagnostics 2024, 14(2), 199; https://doi.org/10.3390/diagnostics14020199 - 16 Jan 2024
Viewed by 1312
Abstract
The existing literature has explored carpal tunnel syndrome (CTS) and determined that it could be a risk for coronary artery disease (CAD), but there has been little research comparing the relevance of CAD with other neuromuscular disorders (NMDs) to CTS. This case–control study [...] Read more.
The existing literature has explored carpal tunnel syndrome (CTS) and determined that it could be a risk for coronary artery disease (CAD), but there has been little research comparing the relevance of CAD with other neuromuscular disorders (NMDs) to CTS. This case–control study explored the association between CTS, stenosing tenosynovitis (ST), and ulnar side NMDs and CAD. The study utilized data from Taiwan’s National Health Insurance Research Database, focusing on health insurance claims. Between January 2000 and December 2011, we employed the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes to identify 64,025 CAD patients as the case group. The control group consisted of an equal number of individuals without CAD, matched for age, sex, and index year of CAD. Logistic regression analysis was employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for each variable. Multivariate analysis, after adjusting for sociodemographic factors and comorbidities, revealed a significantly higher likelihood of a previous diagnosis of CTS in the CAD group compared to the comparison control group. However, neither ST nor the ulnar side NMDs had any statistical significance. These results indicated that median nerve injury, rather than other NMDs, may uniquely serve as a predisposing factor of CAD. Full article
(This article belongs to the Special Issue Peripheral Neuropathy and Related Diseases: Symptoms, Diagnosis, and Treatment)
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14 pages, 1394 KiB  
Article
Corneal Confocal Microscopy Predicts Cardiovascular and Cerebrovascular Events and Demonstrates Greater Peripheral Neuropathy in Patients with Type 1 Diabetes and Foot Ulcers
by Jonathan Z. M. Lim, Jamie Burgess, Cheong Ooi, Maryam Ferdousi, Shazli Azmi, Alise Kalteniece, Matthew Anson, Daniel J. Cuthbertson, Ioannis N. Petropoulos, Rayaz A. Malik, John P. H. Wilding and Uazman Alam
Diagnostics 2023, 13(17), 2793; https://doi.org/10.3390/diagnostics13172793 - 29 Aug 2023
Cited by 3 | Viewed by 1868
Abstract
Objective: In this study, we evaluate small and large nerve fibre pathology in relation to diabetic foot ulceration (DFU) and incident cardiovascular and cerebrovascular events in type 1 diabetes (T1D). Methods: A prospective observational study was conducted on people with T1D without diabetic [...] Read more.
Objective: In this study, we evaluate small and large nerve fibre pathology in relation to diabetic foot ulceration (DFU) and incident cardiovascular and cerebrovascular events in type 1 diabetes (T1D). Methods: A prospective observational study was conducted on people with T1D without diabetic peripheral neuropathy (DPN) (n = 25), T1D with DPN (n = 28), T1D with DFU (n = 25) and 32 healthy volunteers. ROC analysis of parameters was conducted to diagnose DPN and DFU, and multivariate Cox regression analysis was performed to evaluate the predictive ability of corneal nerves for cardiac and cerebrovascular events over 3 years. Results: Corneal nerve fibre length (CNFL), fibre density (CNFD) and branch density (CNBD) were lower in T1D-DPN and T1D-DFU vs. T1D (all p < 0.001). In ROC analysis, CNFD (sensitivity 88%, specificity 87%; AUC 0.93; p < 0.001; optimal cut-off 7.35 no/mm2) and CNFL (sensitivity 76%, specificity 77%; AUC 0.90; p < 0.001; optimal cut-off 7.01 mm/mm2) had good ability to differentiate T1D with and without DFU. Incident cardiovascular events (p < 0.001) and cerebrovascular events (p < 0.001) were significantly higher in T1D-DPN and T1D-DFU. Corneal nerve loss, specifically CNFD predicted incident cardiovascular (HR 1.67, 95% CI 1.12 to 2.50, p = 0.01) and cerebrovascular (HR 1.55, 95% CI 1.06 to 2.26, p = 0.02) events. Conclusions: Our study provides threshold values for corneal nerve fibre metrics for neuropathic foot at risk of DFU and further demonstrates that lower CNFD predicts incident cardiovascular and cerebrovascular events in T1D. Full article
(This article belongs to the Special Issue Peripheral Neuropathy and Related Diseases: Symptoms, Diagnosis, and Treatment)
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Review

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24 pages, 6640 KiB  
Review
The Unpredictable Ulnar Nerve—Ulnar Nerve Entrapment from Anatomical, Pathophysiological, and Biopsychosocial Aspects
by Erika Nyman and Lars B. Dahlin
Diagnostics 2024, 14(5), 489; https://doi.org/10.3390/diagnostics14050489 - 24 Feb 2024
Cited by 6 | Viewed by 5998
Abstract
Peripheral nerves consist of delicate structures, including a rich microvascular system, that protect and nourish axons and associated Schwann cells. Nerves are sensitive to internal and external trauma, such as compression and stretching. Ulnar nerve entrapment, the second most prevalent nerve entrapment disorder [...] Read more.
Peripheral nerves consist of delicate structures, including a rich microvascular system, that protect and nourish axons and associated Schwann cells. Nerves are sensitive to internal and external trauma, such as compression and stretching. Ulnar nerve entrapment, the second most prevalent nerve entrapment disorder after carpal tunnel syndrome, appears frequently at the elbow. Although often idiopathic, known risk factors, including obesity, smoking, diabetes, and vibration exposure, occur. It exists in all adult ages (mean age 40–50 years), but seldom affects individuals in their adolescence or younger. The patient population is heterogeneous with great co-morbidity, including other nerve entrapment disorders. Typical early symptoms are paresthesia and numbness in the ulnar fingers, followed by decreased sensory function and muscle weakness. Pre- and postoperative neuropathic pain is relatively common, independent of other symptom severity, with a risk for serious consequences. A multimodal treatment strategy is necessary. Mild to moderate symptoms are usually treated conservatively, while surgery is an option when conservative treatment fails or in severe cases. The decision to perform surgery might be difficult, and the outcome is unpredictable with the risk of complications. There is no consensus on the choice of surgical method, but simple decompression is relatively effective with a lower complication rate than transposition. Full article
(This article belongs to the Special Issue Peripheral Neuropathy and Related Diseases: Symptoms, Diagnosis, and Treatment)
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17 pages, 4647 KiB  
Review
Diagnostic Approach to Lower Limb Entrapment Neuropathies: A Narrative Literature Review
by Nicu Cătălin Drăghici, Vitalie Văcăraș, Roxana Bolchis, Atamyrat Bashimov, Diana Maria Domnița, Silvina Iluț, Livia Livinț Popa, Tudor Dimitrie Lupescu and Dafin Fior Mureșanu
Diagnostics 2023, 13(21), 3385; https://doi.org/10.3390/diagnostics13213385 - 4 Nov 2023
Cited by 6 | Viewed by 8140
Abstract
Entrapment neuropathies of the lower limb are a misunderstood and underdiagnosed group of disorders, characterized by pain and dysesthesia, muscular weakness, and specific provoking movements on physical examination. The most frequent of these syndromes encountered in clinical practice are fibular nerve entrapment, proximal [...] Read more.
Entrapment neuropathies of the lower limb are a misunderstood and underdiagnosed group of disorders, characterized by pain and dysesthesia, muscular weakness, and specific provoking movements on physical examination. The most frequent of these syndromes encountered in clinical practice are fibular nerve entrapment, proximal tibial neuropathy, sural nerve neuropathy, deep gluteal syndrome or sciatic nerve entrapment, and lateral femoral cutaneous nerve entrapment, also known as meralgia paresthetica. These are commonly mistaken for lumbar plexopathies, radiculopathies, and musculotendinous diseases, which appear even more frequently and have overlapping clinical presentations. A comprehensive anamnesis, physical examination, and electrodiagnostic studies should help clarify the diagnosis. If the diagnosis is still unclear or a secondary cause of entrapment is suspected, magnetic resonance neurography, MRI, or ultrasonography should be conducted to clarify the etiology, rule out other diseases, and confirm the diagnosis. The aim of this narrative review was to help clinicians gain familiarity with this disease, with an increase in diagnostic confidence, leading to early diagnosis of nerve damage and prevention of muscle atrophy. We reviewed the epidemiology, anatomy, pathophysiology, etiology, clinical presentation, and EDX technique and interpretation of the entrapment neuropathies of the lower limb, using articles published from 1970 to 2022 included in the Pubmed, MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Scopus databases. Full article
(This article belongs to the Special Issue Peripheral Neuropathy and Related Diseases: Symptoms, Diagnosis, and Treatment)
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