Published online Sep 15, 2016. doi: 10.4239/wjd.v7.i17.342
Peer-review started: March 26, 2016
First decision: May 13, 2016
Revised: July 9, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: September 15, 2016
Neuropathy is a common complication of diabetes mellitus (DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies (EN), which are focal forms, are so frequent at any stage of the diabetic disease, that they may be considered a neurophysiological hallmark of peripheral nerve involvement in DM. Indeed, EN may be the earliest neurophysiological abnormalities in DM, particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. This remarkable frequency of EN in diabetes is underlain by a peculiar pathophysiological background. Due to the metabolic alterations consequent to abnormal glucose metabolism, the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage, making them more prone to entrapment in anatomically constrained channels. This review discusses the most common and relevant EN encountered in diabetic patient in their epidemiological, pathophysiological and diagnostic features.
Core tip: Diabetic neuropathy syndromes include both generalized and focal/multifocal forms. Entrapment neuropathies (EN) are remarkably frequent in the focal forms and may be the earliest neurophysiological abnormalities in diabetes, even in the absence of a generalized polyneuropathy. Based on a pathophysiological hypothesis, diabetic patients’ peripheral nerves, damaged by the altered glucose metabolism, show both functional impairment and structural changes. This makes them more susceptible to chronic compression in anatomically constrained channels. Therefore, EN may be considered a neurophysiological hallmark of peripheral nerve involvement in diabetes mellitus.