About neuropathy, nerve pain and neuromuscular disorders
A single nerve can also be compressed, as in carpal tunnel syndrome at the wrist or ulnar neuropathy at the elbow, producing numbness in a particular pattern. Nerve root compression from the spine causes sciatica and its equivalent in the arm.
Neuromuscular disorders are conditions of the muscles themselves or of the junction between nerve and muscle, such as myasthenia gravis and the inflammatory and inherited muscle diseases. Dr Ibrahim Imam has a special interest in neuropathies and neuromuscular disorders.
Symptoms we assess
Reasons for referral include:
- Numbness, pins and needles or burning in the feet or hands
- Pain that is worse at night or feels electric or shooting
- Weakness in the hands or feet, tripping, or difficulty with buttons
- Loss of balance, particularly in the dark
- Muscle weakness that worsens with use, drooping eyelids or double vision
- Muscle wasting, cramps or twitching
- Neuropathy in someone with diabetes that is progressing or painful
How we diagnose it
The consultant maps the pattern of symptoms and signs, which points to whether one nerve, many nerves, the nerve roots or the muscles are involved, and to the likely cause. Examination tests sensation, strength, reflexes and coordination. Blood tests look for diabetes, vitamin deficiency, thyroid and liver disease, inflammatory markers, abnormal proteins and, where indicated, specific antibodies or genetic causes.
Nerve conduction studies and electromyography (EMG) measure how well the nerves conduct and how the muscles respond, and are arranged through the host hospital. They confirm the diagnosis, show whether the problem is with the nerve fibre or its insulation, and grade its severity. MRI of the spine is used for suspected root compression, and muscle imaging or biopsy for muscle disease.
Treatment and follow-up
Treatment starts with the cause. Good glucose control slows diabetic neuropathy; replacing vitamin B12, stopping alcohol or a causative medicine, and treating thyroid disease can halt or reverse the damage. Immune-mediated neuropathies such as CIDP are treated with immunotherapy. Carpal tunnel syndrome is treated with splinting, steroid injection or a small operation.
Nerve pain is treated with medicines that act on nerve signalling rather than ordinary painkillers, which rarely work well. Several classes are available and the consultant chooses for your circumstances, adjusting at follow-up. Topical treatments and, in selected cases, specialist pain interventions are options.
Physiotherapy, foot care and balance training reduce the risk of falls and ulcers. Myasthenia gravis and muscle diseases have specific treatments and are followed long term. Your GP receives a plan after every visit.
When to see a GP, and when to see a consultant
Mild numbness in someone with known diabetes can be monitored by the GP. See a neurologist for neuropathy that is progressing, painful, or of unknown cause, for weakness of any kind, for symptoms that started rapidly over days, or for suspected muscle disease. Rapidly worsening weakness or difficulty breathing or swallowing needs emergency care.
