Amyotrophic lateral sclerosis , or ALS, is a progressive nervous system disease that affects nerve cells in the brain and spinal cord, causing loss of muscle control.

ALS is often called Lou Gehrig’s disease, after the baseball player who was diagnosed with it. Doctors usually don’t know why ALS occurs. Some cases are inherited.

ALS often begins with muscle twitching and weakness in a limb, or slurred speech. Eventually, ALS affects control of the muscles needed to move, speak, eat and breathe. There is no cure for this fatal disease.

Symptoms

Signs and symptoms of ALS vary greatly from person to person, depending on which neurons are affected. It generally begins with muscle weakness that spreads and gets worse over time. Signs and symptoms might include:

Difficulty walking or doing normal daily activities

Tripping and falling

Weakness in your legs, feet or ankles

Hand weakness or clumsiness

Slurred speech or trouble swallowing

Muscle cramps and twitching in your arms, shoulders and tongue

Inappropriate crying, laughing or yawning

Cognitive and behavioral changes

ALS often starts in the hands, feet or limbs, and then spreads to other parts of your body. As the disease advances and nerve cells are destroyed, your muscles get weaker. This eventually affects chewing, swallowing, speaking and breathing.

There’s generally no pain in the early stages of ALS, and pain is uncommon in the later stages. ALS doesn’t usually affect your bladder control or your senses.

What is Brachial Plexopathy?

The brachial plexus is a group of spinal nerves that extend through the arm to the hand. Nerve roots leave the neck and shoulder where nerves from the spinal cord divide into the specific nerves for the arm to form a web. Brachial plexopathy occurs when the brachial plexus is not operating correctly, causing a lack of movement and lack of feeling in the arm and shoulder. It can be caused by disease, most commonly an autoimmune disorder that can cause a painful neuritis in the shoulder. In this condition, often called brachial neuritis, the immune system is switched on and overactive for a short time, and then symptoms begin to slowly improve. These symptoms can also be caused by traumatic injury to the area. Damage to it can cause numbness, tingling, pain, and weakness in various areas of the arm, hand and shoulder, depending on which part of the plexus is injured.

Who gets Brachial Plexopathy?

Brachial plexopathy is caused by inflammation, direct trauma, stretch injuries, pressure from tumors in the area, and radiation therapy to the brachial plexus. It may also be caused during birth. As the baby is being delivered, its shoulders may be wedged in the birth canal, which causes the brachial plexus to stretch and tear. 2 out of 10,000 babies may develop brachial plexopathy. However, children and adults can also develop it as a neuritis or by injuring their brachial plexus, which often happens in automobile accidents. Recovery is usually satisfactory after brachial neuritis, but may not occur in cases of severe injury.

How is Brachial Plexopathy diagnosed?

Brachial plexopathy can be diagnosed by EMGs, nerve conduction studies, and MRI scans.

How is Brachial Plexopathy treated?

Treatment for brachial plexopathy is aimed at restoring independence . This can include physical therapy, braces and splints, analgesics, and rarely corticosteroids, and surgery.

Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and forearm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.

In most patients, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness. for this reason, it is important to diagnose and treat carpal tunnel syndrome by the NCS / EMG Test . Early symptoms can often be relieved with simple measures like:

Wearing a wrist splint while sleeping

Exercises to keep the nerve mobile

Avoiding certain activities that aggravate your symptoms

A steroid injection into the carpal tunnel

If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.

Neuropathy is damage or dysfunction of one or more nerves that typically results in numbness, tingling, muscle weakness and pain in the affected area. Neuropathies frequently start in your hands and feet, but other parts of your body can be affected too.

Neuropathy, often called peripheral neuropathy, indicates a problem within the peripheral nervous system. Your peripheral nervous system is the network of nerves outside your brain and spinal cord. Your brain and spinal cord make up your central nervous system. Think of the two systems working together this way: Your central nervous system is the central station. It is the control center, the hub from which all trains come and go. Your peripheral nervous system are the tracks that connect to the central station. The tracks (the network of nerves) allow the trains (information signals) to travel to and from the central station (your brain and spinal cord).

Neuropathy results when nerve cells, called neurons, are damaged or destroyed. This disrupts the way the neurons communicate with each other and with the brain. Neuropathy can affect one nerve (mononeuropathy) or nerve type, a combination of nerves in a limited area (multifocal neuropathy) or many peripheral nerves throughout the body (polyneuropathy).

 

What types of peripheral nerves are there and what do they do?

The peripheral nervous system is made up of three types of nerves, each with an important role in keeping your body healthy and functioning properly.

• Sensory nerves carry messages from your five senses (sight, hearing, smell, taste, touch) through your spinal cord to your brain. For example, a sensory nerve would communicate to your brain information about objects you hold in your hand, like pain, temperature, and texture.
• Motor nerves travel in the opposite direction of sensory nerves. They carry messages from your brain to your muscles. They tell your muscles how and when to contract to produce movement. For example, to move your hand away from something hot.
• Autonomic nerves are responsible for body functions that occur outside of your direct control, such as breathing, digestion, heart rate, blood pressure, sweating, bladder control and sexual arousal. The autonomic nerves are constantly monitoring and responding to external stresses and bodily needs. For instance, when you exercise, your body temperatures increases. The autonomic nervous system triggers sweating to prevent your body’s temperature from rising too high.

The type of symptoms you feel depend on the type of nerve that is damaged.

 

What does neuropathy feel like?

If you have neuropathy, the most commonly described feelings are sensations of numbness, tingling (“pins and needles”), and weakness in the area of the body affected. Other sensations include sharp, lightening-like pain; or a burning, throbbing or stabbing pain.

 

How common is neuropathy? Who gets neuropathy?

Neuropathy is very common. The condition affects people of all ages; however, older people are at increased risk. About 8% of adults over 65 years of age report some degree of neuropathy. Other than age, some of the more common risk factors for neuropathy include diabetes, metabolic syndrome (high blood pressure, high cholesterol, obesity, diabetes), and heavy alcohol use. People in certain professions, such as those that require repetitive motions, have a greater chance of developing mononeuropathies from trauma or compression of nerves.

Among other commonly cited statistics, neuropathy is present in:

• 60% to 70% of people with diabetes.
• 30% to 40% of people who receive chemotherapy to treat cancer.
• 30% of people who have human immunodeficiency virus (HIV).

 

How quickly does neuropathy develop?

Some peripheral neuropathies develop slowly – over months to years – while others develop more rapidly and continue to get worse. There are over 100 types of neuropathies and each type can develop differently. The way your condition progresses and how quickly your symptoms start can vary greatly depending on the type of nerve or nerves damaged, and the underlying cause of the condition.

Charcot -Marie-Tooth disease is a group of inherited disorders that cause nerve damage. This damage is mostly in the arms and legs (peripheral nerves). Charcot-Marie-Tooth disease is also called hereditary motor and sensory neuropathy.

Charcot-Marie-Tooth disease results in smaller, weaker muscles. You may also experience loss of sensation and muscle contractions, and difficulty walking. Foot deformities such as hammertoes and high arches also are common. Symptoms usually begin in the feet and legs, but they may eventually affect your hands and arms. Symptoms of Charcot-Marie-Tooth disease typically appear in adolescence or early adulthood, but may also develop in midlife.

 

Symptoms

Signs and symptoms of Charcot-Marie-Tooth disease may include:

Weakness in your legs, ankles and feet

Loss of muscle bulk in your legs and feet

High foot arches

Curled toes (hammertoes)

Decreased ability to run

Difficulty lifting your foot at the ankle (footdrop)

Awkward or higher than normal step (gait)

Frequent tripping or falling

Decreased sensation or a loss of feeling in your legs and feet

As Charcot-Marie-Tooth disease progresses, symptoms may spread from the feet and legs to the hands and arms. The severity of symptoms can vary greatly from person to person, even among family members.

 

Causes

Charcot-Marie-Tooth disease is an inherited, genetic condition. It occurs when there are mutations in the genes that affect the nerves in your feet, legs, hands and arms.

Sometimes, these mutations damage the nerves. Other mutations damage the protective coating that surrounds the nerve (myelin sheath). Both cause weaker messages to travel between your limbs and brain.

 

Risk factors

Charcot-Marie-Tooth disease is hereditary, so you’re at higher risk of developing the disorder if anyone in your immediate family has the disease.

Other causes of neuropathies, such as diabetes, may cause symptoms similar to Charcot-Marie-Tooth disease. These other conditions can also cause the symptoms of Charcot-Marie-Tooth disease to become worse. Medications such as the chemotherapy drugs vincristine (Marqibo), paclitaxel (Abraxane) and others can make symptoms worse. Be sure to let your doctor know about all of the medications you’re taking.

 

Complications

Complications of Charcot-Marie-Tooth disease vary in severity from person to person. Foot abnormalities and difficulty walking are usually the most serious problems. Muscles may get weaker, and you may injure areas of the body that experience decreased sensation.

Sometimes the muscles in your feet may not receive your brain’s signal to contract, so you’re more likely to trip and fall. And your brain may not receive pain messages from your feet, so if you’ve rubbed a blister on your toe, for example, it may get infected without your realizing it.

You may also experience difficulty breathing, swallowing or speaking if the muscles that control these functions are affected by Charcot-Marie-Tooth disease.

Myasthenia gravis , also known simply as MG, is a rare neuromuscular disorder. When the first case of MG was documented in 1672 by Thomas Willis, an Oxford physician, not much was known or understood about it. Today, we know there are multiple causes for MG as well as treatment options.

Myasthenia gravis (MG) is the most common primary disorder of neuromuscular transmission. The usual cause is an acquired immunological abnormality, but some cases result from genetic abnormalities at the neuromuscular junction. Much has been learned about the pathophysiology and immunopathology of myasthenia gravis during the past 20 years. What was once a relatively obscure condition of interest primarily to neurologists is now the best characterized and understood autoimmune disease. A wide range of potentially effective treatments are available, many of which have implications for the treatment of other autoimmune disorders.

 

What Happens in Your Body

The voluntary muscles of the entire body are controlled by nerve impulses that arise in the brain. These impulses travel down the nerves to the place where the nerves meet the muscle fibers. Nerve fibers do not actually connect with muscle fibers. There is a space between the nerve ending and muscle fiber, called the neuromuscular junction.

When the nerve impulse originating in the brain arrives at the nerve ending, it releases a chemical called acetylcholine. Acetylcholine travels across the space to the muscle fiber side of the neuromuscular junction where it attaches to many receptor sites. The muscle contracts when enough of the receptor sites have been activated by the acetylcholine.

For someone with MG, there can be as much as an 80% reduction in the number of these receptor sites. The reduction in the number of receptor sites is caused by an antibody that destroys or blocks the receptor site. Antibodies are proteins that play an important role in the immune system. They are normally directed at foreign proteins called antigens that attack the body. Such foreign proteins include bacteria and viruses. Antibodies help the body to protect itself from these foreign proteins.

While it is not still fully understood why, the immune system of the person with MG makes antibodies against the receptor sites of the neuromuscular junction. The antibodies destroy the receptor sites more rapidly than the body can replace them. Muscle weakness occurs when acetylcholine cannot activate enough receptor sites at the neuromuscular junction.

When it comes to diagnosing MG, abnormal antibodies can be measured in the blood of most people with MG, but not all.

Myopathy is a general term referring to any disease that affects the muscles that control voluntary movement in the body. Patients experience muscle weakness due to a dysfunction of the muscle fibers. Some myopathies are genetic and can be passed from parent to child. Others are acquired later in life and can be due to autoimmune disease, known as myositis, metabolic disorders or other causes.

 

Symptoms

There are several different types of genetic myopathies, most of which have similar symptoms. These include:

Muscle weakness

Motor delay

Respiratory impairment

Bulbar muscle dysfunction (malfunction of the muscles responsible for swallowing and speech)

Bulbar muscle dysfunctions can be especially apparent in congenital myopathies (those present from birth), and can result in severe impairments to swallowing and speech abilities. Congenital myopathies also are characterized by developmental motor delays and, at times, facial or skeletal abnormalities.

Acquired myopathies may have symptoms similar to those of genetic myopathies and also may include:

Muscle weakness

Muscle soreness (myalgias)

Cramps

Stiffness

Muscle wasting around the shoulders and hips

 

Causes and Risk Factors

Patients who have a blood relative with a genetic myopathy have an increased risk for developing the condition. Depending on how the myopathy is inherited, men can be at greater risk than women of developing the condition. Myopathies carried on the X chromosome affect more men than women, while those carried on chromosomes other than the sex chromosome affect both men and women equally.

Patients may be at increased risk of developing acquired myopathy if they have an autoimmune disorder, metabolic or endocrine disorder, are on certain drugs or are exposed to certain toxins.

 

Diagnosis

The patient’s physician may use a variety of tests to determine the specific myopathy. These can include:

A physical exam

Muscle strength tests

Electromyography (EMG)

Ultrasound

Magnetic resonance imaging (MRI)

Genetic tests

A muscle biopsy

The goal in determining the specific myopathy of each patient is to enable the development of a personalized treatment plan.

 

Treatment

While there is no cure for genetic myopathy, many different treatment options are available to manage the symptoms. Treatments for both genetic and endocrine myopathy are most effective when the disease is diagnosed early and a comprehensive treatment plan is overseen by a knowledgeable medical team, such as those at Cedars-Sinai’s Neuromuscular Disorders Program.

For acquired myopathies due to the immune system, such as dermatomyositis and polymyositis, medications that work to reduce the body’s immune response and decrease inflammation, such as corticosteroids or other immunosuppressants, can help manage some symptoms. Physical therapy, supportive devices such as braces, and sometimes surgery may also be used as treatment tools.

Treatment of metabolic, toxic and endocrine-related myopathy generally focuses on the underlying cause of the condition. Medication or surgery may be used to address the symptoms.

SYMPTOMS AND CAUSES

What causes neuropathy?

Neuropathy is not caused by a single disease. Many conditions and events that impact health can cause neuropathy, including:

• Diabetes: This is a leading cause of neuropathy . Some 60% to 70% of people with diabetes experience neuropathy. Diabetes is the most common cause of small fiber neuropathy, a condition that causes painful burning sensations in the hands and feet.
• Trauma: Injuries from falls, car accidents, fractures or sports activities can result in neuropathy. Compression of the nerves due to repetitive stress or narrowing of the space through which nerves run are other causes.
• Autoimmune disorders and infections: Guillain-Barré syndrome, lupus, rheumatoid arthritis, Sjogren’s syndrome and chronic inflammatory demyelinating polyneuropathy are autoimmune disorders that can cause neuropathy. Infections including chickenpox, shingles, human immunodeficiency virus (HIV), herpes, syphilis, Lyme disease, leprosy, West Nile virus, Epstein-Barr virus and hepatitis C can also cause neuropathy.
• Other health conditions: Neuropathy can result from kidney disorders, liver disorders, hypothyroidism, tumors (cancer-causing or benign) that press on nerves or invade their space, myeloma, lymphoma and monoclonal gammopathy.
• Medications and poisons: Some antibiotics, some anti-seizures medications and some HIV medications among others can cause neuropathy. Some treatments, including cancer chemotherapy and radiation, can damage peripheral nerves. Exposure to toxic substances such as heavy metals (including lead and mercury) and industrial chemicals, especially solvents, can also affect nerve function.
• Vascular disorders: Neuropathy can occur when blood flow to the arms and legs is decreased or slowed by inflammation, blood clots, or other blood vessel disorders. Decreased blood flow deprives the nerve cells of oxygen, causing nerve damage or nerve cell death. Vascular problems can be caused by vasculitis, smoking and diabetes.
• Abnormal vitamin levels and alcoholism: Proper levels of vitamins E, B1, B6, B12, and niacin are important for healthy nerve function. Chronic alcoholism, which typically results in lack of a well-rounded diet, robs the body of thiamine and other essential nutrients needed for nerve function. Alcohol may also be directly toxic to peripheral nerves.
• Inherited disorders: Charcot-Marie-Tooth (CMT) disease is the most common hereditary neuropathy. CMT causes weakness in the foot and lower leg muscles and can also affect the muscles in the hands. Familial amyloidosis, Fabry disease and metachromatic leukodystrophy are other examples of inherited disorders that can cause neuropathy.
• No known cause: Some cases of neuropathy have no known cause.

 

What are the symptoms of neuropathy?

Symptoms of neuropathy vary depending on the type and location of the nerves involved. Symptoms can appear suddenly, which is called acute neuropathy, or develop slowly over time, called chronic neuropathy.

 

Common signs and symptoms of neuropathy include:

• Tingling (“pins and needles”) or numbness, especially in the hands and feet. Sensations can spread to the arms and legs.
• Sharp, burning, throbbing, stabbing or electric-like pain.
• Changes in sensation. Severe pain, especially at night. Inability to feel pain, pressure, temperature or touch. Extreme sensitivity to touch.
• Falling, loss of coordination.
• Not being able to feel things in your feet and hands – feeling like you’re wearing socks or gloves when you’re not.
• Muscle weakness, difficulty walking or moving your arms or legs.
• Muscle twitching, cramps and/or spasms.
• Inability to move a part of the body (paralysis). Loss of muscle control, loss of muscle tone or dropping things out of your hand.
• Low blood pressure or abnormal heart rate, which causes dizziness when standing up, fainting or lightheadedness.
• Sweating too much or not enough in relation to the temperature or degree or exertion.
• Problems with bladder (urination), digestion (including bloating, nausea/vomiting) and bowels (including diarrhea, constipation).
• Sexual function problems.
• Weight loss (unintentional).

DIAGNOSIS AND TESTS

Common symptoms of neuropathy include numbness and tingling, frequent falls, muscle weakness and difficulty walking, and low blood pressure.

How is neuropathy diagnosed?

History and physical exam: First, your doctor will conduct a thorough history and physical exam. You doctor will review your symptoms and ask questions including your current and past medications, exposure to toxic substances, your history of trauma, your line of work or social habits (looking for repetitive motions), family history of diseases of the nervous system, your diet and alcohol use.

Neurologic exam: During a neurologic exam, your doctor will check your reflexes, your coordination and balance, your muscle strength and tone, and your ability to feel sensations (such as light touch or cold).

Blood work and imaging tests: Your doctor may also order blood work and imaging tests. Blood work can reveal vitamin and mineral imbalances, electrolyte imbalances (indicator of kidney problems, diabetes, other health issues), thyroid problems, toxic substances, antibodies to certain viruses or autoimmune diseases. Magnetic resonance imaging (MRI) can detect tumors, pinched nerves and nerve compression.

Genetic testing: A genetic test may be ordered if your doctor suspects a genetic condition is causing your neuropathy.

Electrodiagnostic assessment (EDX): Your doctor might send you to a nerve specialist for an EDX to find the location and degree of nerve damage. EDX includes two tests:

• Nerve conduction study (NCS): During this test, small patches – called electrodes – are placed on the skin over nerves and muscles on different parts of your body, usually your arms or legs. A brief pulse of electricity is applied to the patch over a nerve to be studied. The test measures the size of the response and how quickly the nerve is carrying the electrical signal. Both motor and sensory nerves can be studied in this way.
• Needle electromyography (EMG): An EMG can determine the health of a muscle, and determine if there is any disconnection between the nerve and muscle by measuring the electrical activity within the muscle while it is in use. During an EMG, a very thin needle electrode is inserted through the skin into the muscle. The muscle is then used for a specific movement and the electrical activity of the muscle is recorded on a graph called an electromyogram.

Tissue biopsies: In some cases, a nerve, muscle or skin biopsy is needed to confirm the diagnosis. During a biopsy, a small sample of your tissue is removed for examination under a microscope.

Other tests: Other tests include a test to measure your body’s ability to sweat (called a QSART test) and other tests to check the sensitivity of your senses (touch, heat/cold, pain, vibration).

MANAGEMENT AND TREATMENT

How is neuropathy treated?

Treatment begins by identifying and treating any underlying medical problem, such as diabetes or infections.

Some cases of neuropathy can be easily treated and sometimes cured. Not all neuropathies can be cured, however. In these cases, treatment is aimed at controlling and managing symptoms and preventing further nerve damage. Treatment options include the following:

• Medicines can be used to control pain. A number of different medications contain chemicals that help control pain by adjusting pain signaling pathways within the central and peripheral nervous system. These medications include:
  • Antidepressants .
  • Antiseizure medicines .
  • Topical (on the skin).
  • Narcotic medications are not usually used for neuropathy pain due to limited evidence that they are helpful for this condition.
• Physical therapy uses a combination of focused exercise, massage and other treatments to help you increase your strength, balance and range of motion.
• Occupational therapy can help you cope with the pain and loss of function, and teach you skills to make up for that loss.
• Surgery is available for patients with compression-related neuropathy caused by such things as herniated disc in back or neck, tumors, infections, or nerve entrapment disorders, such as carpal tunnel syndrome.
• Mechanical aids, such as braces and specially designed shoes, casts and splints can help reduce pain by providing support or keeping the affected nerves in proper alignment.
• Proper nutrition involves eating a healthier diet and making sure to get the right balance of vitamins and other nutrients.
• Adopting healthy living habits, including exercising to improve muscle strength, quitting smoking, maintaining a healthy weight, and limiting alcohol intake.

 

Other treatments

• Transcutaneous electrical nerve stimulation (TENS): This treatment involves placing electrodes on the skin at or near the nerves causing your pain. A gentle, low-level electrical current is delivered through the electrodes to your skin. Treatment schedule (how many minutes and how often) is determined by your therapist. The goal of TENS therapy is to disrupt pain signals so they don’t reach the brain
• Immune suppressing or immune modulating treatments: Various treatments are used for individuals whose neuropathy is due to an autoimmune disease. These include oral medications, IV infusion treatments, or even procedures like plasmapheresis where antibodies and other immune system cells are removed from your blood and the blood is then returned to your body. The goal of these therapies is to stop the immune system from attacking the nerves.
• Complementary treatments: Acupuncture, massage, alpha-lipoic acid, herbal products, meditation/yoga, behavioral therapy and psychotherapy are other methods that could be tried to help relieve neuropathic pain. Ask your doctor if any of these therapies might be helpful for treating the cause of your neuropathy.

 

PREVENTION

Can neuropathy be prevented?

You can reduce your risk of neuropathy by treating existing medical problems and adopting healthy living habits. Here are some tips:

• Manage your diabetes: If you have diabetes, keep your blood glucose level within the range recommended by your doctor.
• Take care of your feet: If you have diabetes or poor blood flow, it’s important to check your feet every day. Look for sores, blisters, redness, calluses, or dry or cracking skin. Keep your toenails clipped (clip straight across the nail); apply lotion to clean, dry feet; and wear closed-toe, well-fitting shoes. Protect your feet from heat and cold. Don’t walk barefoot.
• Declutter your floors: Keep your floors free of items that could cause you to trip and fall. Make sure all electrical cords are tucked away along the baseboards of walls and rooms are well lit.
• Stop smoking: Smoking constricts blood vessels that supply nutrients to nerves. Without proper nutrition, neuropathy symptoms can worsen.
• Maintain a healthy lifestyle: Eat a balanced diet, stay within your ideal weight range, exercise several times a week and keep alcoholic drinks to a minimum. These healthy living tips keep your muscles strong and supply your nerves with the oxygen and nutrients they need to remain healthy.
• Review your medications: Talk with your doctor or pharmacist about all the medications and over-the-counter products you take. Ask if any are known to cause or worsen neuropathy. If so, ask if a different medication can be tried.

 

OUTLOOK / PROGNOSIS

Can neuropathy be stopped?

Your long-term outcome depends on what is causing your neuropathy. If your neuropathy is caused by a treatable condition, managing the condition might result in stopping the neuropathy or preventing it from getting worse. If the underlying cause of the neuropathy can’t be treated, then the goal is to manage the symptoms of neuropathy and improve your quality of life.

Neuropathy rarely leads to death if the cause is determined and controlled. The sooner the diagnosis is made and treatment is started, the greater the chance that nerve damage can be slowed or repaired. Recovery, if it’s possible, usually takes a very long time — from months to even years. Some people live with a degree of neuropathy for the rest of their lives.

Can neuropathy be reversed?

If the underlying cause of the neuropathy can be treated and cured (such as neuropathy caused by a vitamin deficiency), it’s possible that the neuropathy can be reversed too. However, frequently by the time individuals are diagnosed with a neuropathy, there is some degree of permanent damage that can’t be fixed.

Even though this is the general belief of today, it’s not the hope of tomorrow. Nerve damage may be reversible someday. Researchers are already seeing positive results – the regrowth of nerve fibers – in a drug study in mice with diabetes. Ongoing research combined with living a healthy lifestyle so the body can repair itself will likely be needed. Stay tuned.

 

LIVING WITH

Can neuropathy lead to amputation?

Yes, neuropathy – especially diabetes-related neuropathy – can lead to limb amputation. The sequence of events leading up to amputation is typically this: the high glucose levels seen in diabetes cause nerve damage. The nerve damage reduces sensation in the limbs (usually the feet), which can lead to unnoticed injuries turning into skin ulcers or infections. Reduced blood flow to the feet, another effect of diabetes, prevents the wound from healing properly. The wounds cause the tissue in the foot or leg to break down, requiring amputation.

You can, however, reduce your chance of an amputation by keeping your diabetes under control and carefully caring for your skin and feet.

What should I do if I think I have neuropathy?

See your healthcare provider immediately as soon as you notice symptoms. Neuropathy can also be a symptom of a serious disorder. If left untreated, peripheral neuropathy can lead to permanent nerve damage.

Radiculopathy is caused by a pinched nerve in your spine. More specifically, it happens when one of your nerve roots (where your nerves join your spinal column) is compressed or irritated. You might see it referred to as radiculitis.

Radiculopathy will cause the area around your pinched nerve to feel painful, numb or tingly.

Depending on where along your spine the pinched nerve is, your healthcare provider will classify the radiculopathy as one of three types:

• Cervical radiculopathy (neck).
• Thoracic radiculopathy (upper middle back).
• Lumbar radiculopathy (low back).

Usually improving your posture, over-the-counter medicine or at-home physical therapy exercises are the only treatments you’ll need to relieve radiculopathy symptoms. In fact, some cases of radiculopathy improve with no treatment at all.

 

Radiculopathy vs. myelopathy

Both radiculopathy and myelopathy are painful conditions involving your spine. Radiculopathy is a temporary issue caused by a pinched nerve root near your spine. Myelopathy is compression of your spinal cord caused by a trauma, tumor, degenerative disease or infection.

If it’s not treated, myelopathy can worsen over time and cause permanent damage to your nerves. Radiculopathy is a temporary issue that heals over time and often goes away without treatment.

It can be hard to tell what’s causing your pain. That’s why it’s important to talk to your healthcare provider as soon as you notice any new symptoms — especially if they last more than a few days.

 

Radiculopathy vs. spondylolysis

Spondylolysis is a weakness at the point your vertebrae (the bones that make up your spine) connect together. This can lead to small stress fractures that cause pain, usually in your lower back. It usually affects teens going through growth spurts.

Radiculopathy can be caused by bones in your spine moving out of place, but symptoms like pain are caused when your nerve roots are compressed or irritated, and not by a broken bone.

 

Radiculopathy vs. sciatica

Both radiculopathy and sciatica are caused by pinched nerves.

The difference is which nerves are pinched causing the pain. Radiculopathy happens when a nerve along your spine is irritated or compressed. Sciatica is the pain or discomfort you feel when your sciatic nerve — the longest nerve in your body that starts in your lower back and runs down the back of each of your legs — gets compressed or pinched.

Radiculopathy usually hurts in the area of your back near the pinched nerve. Sciatica is a type of radiculopathy that causes pain along your sciatic nerve in your lower back and down your legs.

 

Who does radiculopathy affect?

Radiculopathy can affect anyone, but it’s more common in people older than 50.

 

How common is radiculopathy?

Radiculopathy is rare. While neck pain and back pain — especially lower back pain — are common problems, they’re rarely caused by radiculopathy.

 

How does radiculopathy affect my body?

The most obvious way radiculopathy affects your body is the pain and other symptoms it causes around your pinched nerve.

Depending on how severe your symptoms are — and which type of radiculopathy you have — it might be hard or uncomfortable to sit, stand or move. For example, if you have cervical radiculopathy, it might be painful and difficult to move your neck.

 

SYMPTOMS AND CAUSES

 

What are radiculopathy symptoms?

Symptoms of radiculopathy include:

• Pain in the area around your affected nerve.
• Tingling.
• Numbness.
• Muscle weakness.

Where you experience symptoms depends on which type of radiculopathy you have.

• Cervical radiculopathy: You might have pain and other symptoms in and around your neck, but these symptoms can radiate (spread out) to your arms and hands, too.
• Thoracic radiculopathy: You’ll likely have pain in and around your chest, including when you breathe in and out.
• Lumbar radiculopathy: The pain or numbness in your lower back can spread to your legs.

Some radiculopathy symptoms are similar to other, much more serious issues. Don’t ignore pain in your chest, trouble breathing or numbness in your limbs. Talk to your healthcare provider as soon as you notice these symptoms.

What causes radiculopathy?

Anything that compresses or irritates the roots of your spinal nerves can cause radiculopathy, including:

• Traumas like falls or car accidents.
• Bone spurs growing on one of your vertebrae.
• A herniated disc (also referred to as slipped, ruptured or bulging discs).

You can also develop radiculopathy with no direct cause other than getting older. As you age, your bones and the discs in your spine lose their shape and flexibility. This natural degeneration and weakening can cause your spine to shift enough to pinch a nerve.

 

DIAGNOSIS AND TESTS

 

How is radiculopathy diagnosed?

Your healthcare provider will diagnose radiculopathy with a physical exam and imaging tests. They’ll look at your back and spine, talk to you about your symptoms and ask about the different sensations you’re feeling.

You’ll probably need at least one of a few imaging tests, including:

• X-ray: An X-ray can show narrowing and changing alignment of your spinal cord, as well as any spinal fractures.
• Computed tomography (CT) scan: A CT scan shows 3D images and more detail of your spine than an X-ray can.
• Magnetic resonance imaging (MRI): An MRI can show if damage to soft tissues is causing the nerve compression. It will also show any damage to your spinal cord.
• Electromyography (EMG): An EMG measures electrical impulses in your muscles. This can help determine if a nerve is working as it should. This helps your healthcare provider know if your symptoms are caused by pressure on your spinal nerve roots or if another condition (like diabetes) damaged your nerves.

 

MANAGEMENT AND TREATMENT

How is radiculopathy treated?

Treatment depends on which type of radiculopathy you have (where the pinched nerve is along your spine) and how severe your symptoms are. Some people never need formal treatment if their symptoms improve on their own in a few days or weeks.

If you do need treatment, it might include some or all of the following:

• Ice or heat: Your healthcare provider will tell you how often to ice or apply heat to your back to reduce swelling or relax tight muscles.
• Adjusting your posture or physical therapy: Stretches and exercises that target the area around your spine can help ease pressure on your nerves and relieve pain. Improving your overall posture can help reduce stress on your spine and relieve your symptoms. Your healthcare provider or physical therapist will advise you on which types of exercises are best for the type of radiculopathy you have.

Radiculopathy surgery

It’s rare to need surgery to treat radiculopathy. Your healthcare provider will likely only recommend surgery if you have severe symptoms that affect your quality of life and don’t respond to other treatments. They’ll tell you which type of surgery you’ll need and what to expect.

How do I manage my radiculopathy symptoms?

Talk to your healthcare provider or physical therapist about how you can adjust your posture to make your daily routine more comfortable. They’ll recommend how you can comfortably sit, stand and sleep without aggravating your radiculopathy.

If your healthcare provider or physical therapist shows you stretches or exercises to strengthen your core muscles, try to do them as often as they recommend.

Don’t force yourself to do anything that hurts while you’re recovering, though. It might make your symptoms worse. Talk to your healthcare provider or physical therapist if the exercises they provide you are painful. They’ll tell you how to work through them safely.

How soon after treatment will I feel better?

You should feel better over time as you start treating radiculopathy symptoms. Some people feel better in a few days, but sometimes it takes a few weeks.

 

PREVENTION

How can I prevent radiculopathy?

Many of the causes of radiculopathy can’t be prevented. Maintaining good spine health and posture can help prevent some of the degeneration that can lead to radiculopathy.

 

OUTLOOK / PROGNOSIS

What can I expect if I have radiculopathy?

You should expect to make a full recovery from an episode of radiculopathy. It can be very painful and inconvenient, but it’s usually a temporary condition.

How long does radiculopathy last?

It depends on what caused your radiculopathy, and which type you’re experiencing. In general, most people feel better in a few weeks (or sooner). It might be longer if you have severe symptoms or other conditions that affect your spine.

Will I have to miss work or school?

If you can do your job or schoolwork without aggravating your symptoms, you shouldn’t have to miss work or school while you’re recovering from radiculopathy. Talk to your healthcare provider before resuming any physical activities.

Almost everyone experiences back pain at some point in their lives. There’s a difference between occasional aches and pains and a painful condition like radiculopathy, though. It can be scary to hear that something is wrong near your spine, but all forms of radiculopathy are very treatable and very rarely require surgery. You should make a full recovery with at-home treatments and by giving your body time to heal.