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Focal motor or sensory deficit Deficit is in territory of an individual peripheral nerve An individual nerve may be injured along its course or may be compressed, angulated, or stretched by neighboring anatomic structures, especially at a point where it passes through a narrow space (entrapment neuropathy) The relative contributions of mechanical factors and ischemia to the local damage are not clear With involvement of a sensory or mixed nerve, pain is commonly felt distal to the lesion Symptoms never develop with some entrapment neuropathies, resolve rapidly and spontaneously in others, and become progressively more disabling and distressing in yet other cases The precise neurologic deficit depends on the nerve involved Percussion of the nerve at the site of the lesion may lead to paresthesias in its distal distribution Entrapment neuropathy may be the sole manifestation of subclinical polyneuropathy, and this must be borne in mind and excluded by nerve conduction studies Such studies are also indispensable for the accurate localization of the focal lesion In patients with acute compression neuropathy such as may occur in intoxicated individuals ( Saturday night palsy ), no treatment is necessary Complete recovery generally occurs, usually within 2 months, presumably because the underlying pathology is demyelination However, axonal degeneration can occur in severe cases, and recovery then takes longer and may never be complete In chronic compressive or entrapment neuropathies, avoidance of aggravating factors and correction of any underlying systemic conditions are important Local infiltration of the region about the nerve with corticosteroids may be of value; in addition, surgical decompression may help if there is a progressively increasing neurologic deficit or if electrodiag-

Ulnar nerve lesions are likely to occur in the elbow region as the nerve runs behind the medial epicondyle and descends into the cubital tunnel In the condylar groove, the ulnar nerve is exposed to pressure or trauma Moreover, any increase in the carrying angle of the elbow, whether congenital, degenerative, or traumatic, may cause excessive stretching of the nerve when the elbow is flexed Ulnar nerve lesions may also result from thickening or distortion of the anatomic structures forming the cubital tunnel, and the resulting symptoms may also be aggravated by flexion of the elbow, because the tunnel is then narrowed by tightening of its roof or inward bulging of its floor A severe lesion at either site causes sensory changes in the medial 1 1/2 digits and along the medial border of the hand There is weakness of the ulnar-innervated muscles in the forearm and hand With a cubital tunnel lesion, however, there may be relative sparing of the flexor carpi ulnaris muscle Electrophysiologic evaluation using nerve stimulation techniques allows more precise localization of the lesion If conservative measures are unsuccessful in relieving symptoms and preventing further progression, surgical treatment may be necessary This consists of nerve transposition if the lesion is in the condylar groove, or a release procedure if it is in the cubital tunnel Ulnar nerve lesions may also develop at the wrist or in the palm of the hand, usually owing to repetitive trauma or to compression from ganglia or benign tumors They can be subdivided depending on their presumed site Compressive

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lesions are treated surgically If repetitive mechanical trauma is responsible, this is avoided by occupational adjustment or job retraining

Misplaced deep intramuscular injections are probably still the most common cause of sciatic nerve palsy Trauma to the buttock, hip, or thigh may also be responsible The resulting clinical deficit depends on whether the whole nerve has been affected or only certain fibers In general, the peroneal fibers of the sciatic nerve are more susceptible to damage than those destined for the tibial nerve A sciatic nerve lesion may therefore be difficult to distinguish from peroneal neuropathy unless there is electromyographic evidence of involvement of the short head of the biceps femoris muscle The common peroneal nerve itself may be compressed or injured in the region of the head and neck of the fibula, eg, by sitting with crossed legs or wearing high boots There is weakness of dorsiflexion and eversion of the foot, accompanied by numbness or blunted sensation of the anterolateral aspect of the calf and dorsum of the foot

The radial nerve is particularly liable to compression or injury in the axilla (eg, by crutches or by pressure when the arm hangs over the back of a chair) This leads to weakness or paralysis of all the muscles supplied by the nerve, including the triceps Sensory changes may also occur but are often surprisingly inconspicuous, being marked only in a small area on the back of the hand between the thumb and index finger Injuries to the radial nerve in the spiral groove occur characteristically during deep sleep, as in intoxicated individuals (Saturday night palsy), and there is then sparing of the triceps muscle, which is supplied more proximally The nerve may also be injured at or above the elbow; its purely motor posterior interosseous branch, supplying the extensors of the wrist and fingers, may be involved immediately below the elbow, but then there is sparing of the extensor carpi radialis longus, so that the wrist can still be extended The superficial radial nerve may be compressed by handcuffs or a tight watch strap

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