Constrictive Entrapment Neuropathies of a Limb Secondary to Restraint Strapping: A Case Report
Tiffany Ella Rose Say, Raymond L. Rosales
Dec 2021 DOI 10.35460/2546-1621.2021-0154 Access
Rationale: Entrapment neuropathies are peripheral nerve disorders at specific anatomical locations. They may be caused by trauma in a manner of sprains or bone fracture, but it is often caused by repetitive insults or compression of nerves as they travel through a narrow anatomic space. Pregnancy and pre-existing comorbidities such as diabetes, obesity, cancer, or autoimmune diseases may also cause nerve entrapment.
Objective: To highlight the case of a 52-year-old female developing right foot dysesthesia and weakness after continuous restraint strapping from her previous hospitalization.
Case: Here we have the case of a 52-year-old Filipino female consulted because of right foot dysesthesia, allodynia, and mild weakness. She had a history of bipolar disorder and recent onset of acute psychosis and overdosing with her irregularly taken maintenance olanzapine tablets. She was put on restraint strapping of the right lower limb in her one-week hospital stay. This resulted in developing restraint marks on her right ankle accompanied by difficulty walking on heels and toes, spontaneous dysesthesia, and touch allodynia of her entire right foot. An electrodiagnosis yielded right lower limb focal neuropathies involving the right fibular nerve, right tibial nerve, right superficial fibular, and right sural nerves. The prescribed amitriptyline and gabapentin for 6 months led to gradual improvement of neuropathic pain.
Discussion and Summary: Our case exemplifies focal limb neuropathies from entrapment due to restraint strapping. Electrodiagnostic confirmation of neuropathies of the same limb sensory and motor nerves was mandated to corroborate clinical neuropathic pain and after ruling out other causes of entrapment neuropathies. Prolonged use of neuropathic pain medications were needed to attain relief in this present case. Restrictive strapping is an iatrogenic cause of entrapment neuropathy that is preventable, had there been proper medical attention applied.
Key words: Entrapment neuropathy, mononeuropathy, iatrogenic, nerve compression syndrome, restraints, focal neuropathy, case report
- Hanna AS. Nerve entrapment syndromes treatment & management: Medical therapy, intraoperative details, complications [Internet]. Medscape; 2021 [cited 2021 Dec 25]. Available from: https://emedicine.medscape.com/article/249784-treatment#d9
- He Y. Allodynia [Internet]. StatPearls [Internet]. U.S. National Library of Medicine; 2021 [cited 2021 Dec 25]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537129/
- Hammi C. Neuropathy [Internet]. StatPearls [Internet]. U.S. National Library of Medicine; 2021 [cited 2021 Dec 25]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542220/
- Schmid AB, Fundaun J, Tampin B. Entrapment neuropathies: A contemporary approach to pathophysiology, clinical assessment, and Management. PAIN Reports. 2020;5(4):e829.
- Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease. Journal of the American Academy of Dermatology. 2016;74(2):215–28.
- Jensen TS, Finnerup NB. Allodynia and hyperalgesia in neuropathic pain: Clinical manifestations and mechanisms. The Lancet Neurology. 2014;13(9):924–35.
- Ulloa M, Coronel Banda M. Scar tissue causing saphenous nerve entrapment. Plastic and Reconstructive Surgery - Global Open. 2017;5(9):e1495.
- Azhary H, Farooq MU, Bhanushali M, Majid A, Kassab MY. Peripheral neuropathy: differential diagnosis and management. Am Fam Physician. 2010;81(7):887–92.
- Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev [Internet]. 2015;(7):CD008242. Available from: http://dx.doi.org/10.1002/14651858.CD008242.pub3
- Dosenovic S, Jelicic Kadic A, Miljanovic M, Biocic M, Boric K, Cavar M, et al. Interventions for neuropathic pain. Anesthesia & Analgesia. 2017;125(2):643–52.
Articles related to the one you are viewing
There are currently no results to show, please try again later
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.