Peripheral Nerve Entrapments: Clinical Diagnosis and Management

Peripheral nerve entrapments are a commonly overlooked cause of painful conditions, resulting
in pain literally from the head to the toe. Even the astute clinician may not be aware of these
syndromes, and entrapment of these often small nerves can lead to debilitating pain, mimicking
“migraines,” cardiac disease, intra-abdominal pathology, “endometriosis,” complex regional
pain syndrome (CRPS), and “plantar fasciitis.” Knowledge of these entrapments can prevent
expensive ineffective testing and treatment and can ideally avoid unnecessary pain and
suffering.
This book is a culmination of many years of my personal clinical observations as well ascollaboration between many providers. Over the years, when I would lecture on peripheral
nerve entrapments, I would be met with blank stares, or worse, derision. However, this lack of
knowledge is slowly changing. Fifteen years ago, when I would ask the audience to raise their
hand if they had ever even heard of the cluneal nerve, perhaps two or three hands would go up.
Now, with the same question, sometimes a majority of the room will raise their hands.
This book has been designed to be a guide as well as a reference. We chose pain patternimages that will hopefully trigger the clinician to think about peripheral nerve entrapment as a
cause of their patient’s pain, while at the same time providing the scholarly anatomic
descriptions of the nerve. We hope that this book will help you diagnose as well as treat your
patients, using physical exam, differential diagnosis, medications, injections (landmarkguided,
fl uoroscopic-guided, and ultrasound-guided), neurolytics, neuromodulation, and
surgery. Videos showing the physical exam and landmark-guided injections are included for
most of the described nerves. We have also created an Index of Symptoms, so that a patient
who is complaining of an “ice pick in my eye” should lead you to consider the greater occipital
nerve as a possible etiology.