HNPP · Physical Health

Can HNPP lead to bone-related issues?

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There appears to be a common trend of patients with HNPP having joint-related issues, which seems to go hand-in-hand with the fact that over-compensation on certain limbs, nerve damage, and issues with the feet eventually leads to problems with bones in general.

From osteoporosis to bone spur, entrapments of the nerves can cause a range of complications. Damage due to bone and joint problems at the elbow can be exacerbated by chronic pressure on the elbow and full elbow flexion and vice versa.

Disclaimer: Please ask your medical practitioner or occupational therapist for more information. This article is based on various research, journals and testimonies.

Why does it happen?

Compression of the nerves is an inability to transmit nerve impulses because compression has damaged nerve fibres either directly, or indirectly by restricting their supply of oxygen.

According to the 2000 study Is Bone a Target-Tissue for the Nervous System?, the authors state that there is strong evidence to suggest that bone can be a “target” of the nervous system.

The authors describe: “it seems reasonable that neural control could also apply to bone tissue, and several clinical and experimental observations support this concept, including Charcot’s neuropathy”.

“The distribution of different nerves during bone formation, combined with the observed effects of transmitters on bone metabolism in vitro, suggest that there is neuroendocrine regulation of bone physiology.”

“Is Bone a Target-Tissue for the Nervous System?” – García-Castellano, J. et al, Nov. 2014

Although there are few nerve fibres in bone, their presence may represent sophisticated and specialised regulatory elements able to deliver time- and site-specific stimuli according to demand.  This suggests that the peripheral nervous system is critically involved in bone metabolism, osteogenesis, and bone remodelling through nerve fibres. Various cells of the musculoskeletal system have receptors for sensory and sympathetic neurotransmitters.

This can be seen in the research Neurogenic Arthropathy and Recurring Fractures with Subclinical Inherited Neuropathy. Neurogenic Arthropathy, common in the hereditary condition Charcot Marie-tooth syndrome, is where due to damaged pain perception and position sense, the bones in the foot can rapidly degenerate. The authors say that patients with neuropathic arthropathy also suffer from recurrent long bone fractures owing to underlying sensory neuropathy.

With fractures, the researchers of the 2000 study for the Iowa Orthopaedic Journal explain: “This difference in healing may imply that in fractures with an abnormal nerve supply the sensory innervation does not recognize anomalous movement of the fracture and, with unstable fixation, nerves may mediate signals that lead to altered bone healing.”

They also suggest that with a neurectomy (surgical removal of all or some of the nerve), bones were less likely to grow back adequately, instead there is a decrease in bone mass.

How can nerves become compressed?

Compression can come from herniated discs in the spine, osteoarthritis can cause bone spurs that can compress a nerve, severe muscle injuries can compress nerves, and even prolonged use of tight clothing such as shoes or skinny jeans. It all depends on the nerve compressed.

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This type of pathology produces pain called radicular pain or nerve root pain leading to pain that may radiate to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain from a pinched nerve is usually described as sciatica.

With a herniated disc most compressed nerves will cause inflammation. This is likely to cause problems when the nerve is squashed between the disc and an adjacent bone.

What happens with injuries?

Traumatic injuries caused by accidents for example, can cause nerves to be partially or completely severed, crushed, compressed, or stretched, sometimes so forcefully that they are partially or completely detached from the spinal cord. Broken or dislocated bones can exert damaging pressure on neighbouring nerves, and slipped disks between vertebrae can compress nerve fibres where they emerge from the spinal cord.

What are the different types of musculoskeletal pain?

Musculoskeletal pain has varying symptoms and causes. Some of the more common types of pain include:

  • Bone pain: This is usually deep, penetrating, or dull. It most commonly results from injury. It is important to be sure that the pain is not related to a fracture or tumour.
  • Muscle pain: This is often less intense than bone pain, but it can still be debilitating. Muscle pain can be caused by an injury, an autoimmune reaction, loss of blood flow to the muscle, infection, or a tumour. The pain can also include muscle spasms and cramps.
  • Tendon and ligament pain: Pains in the tendons or ligaments are often caused by injuries, including sprains. This type of musculoskeletal pain often becomes worse when the affected area is stretched or moved.
  • Fibromyalgia: This is a condition that may cause pain in the muscles, tendons, or ligaments. The pain is usually in multiple locations and can be difficult to describe. Fibromyalgia is usually accompanied by other symptoms.
  • Joint pain: Joint injuries and diseases usually produce a stiff, aching, “arthritic” pain. The pain may range from mild to severe and worsens when moving the joint. The joints may also swell. Joint inflammation (arthritis) is a common cause of pain.
  • “Tunnel” syndromes: This refers to musculoskeletal disorders that cause pain due to nerve compression. The disorders include carpal tunnel syndrome, cubital tunnel syndrome, and tarsal tunnel syndrome. The pain tends to spread along the path supplied by the nerve and may feel like burning. These disorders are often caused by overuse.

How is musculoskeletal pain diagnosed?

Your doctor will begin by conducting a thorough medical history. They will then look for possible causes of your pain, and will also ask if the pain is ongoing or acute.

The doctor will then conduct a hands-on examination looking for the source of the pain. This may include palpating the affected area. This helps him or her locate the origin of the pain. However, to determine the underlying cause of the pain, the doctor will often follow the exam with laboratory tests and X-rays.

How is musculoskeletal pain treated?

Different types of physical therapy, or mobilisation, can be used to treat people with spinal alignment problems.

Medications such as nonsteroidal anti-inflammatories (NSAIDs) may be used to treat inflammation or pain.

In patients with musculoskeletal disorders such as fibromyalgia, medications to increase the body’s level of serotonin and norepinephrine (neurotransmitters that modulate sleep, pain, and immune system function) may be prescribed in low doses.

As if HNPP is not enough to deal with, it seems that there is a corresponding issue of joint problems. In this case, you may have to be extra careful with certain activities that may aggravate both issues, such as walking where it may not only cause numbness in the legs, but actual pain on the bone itself. Keeping vigilant is going to be absolutely vital as a result.

Read: Coping with multiple conditions including HNPP

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