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Acute vs. chronic compressive neuropathy

Studies of the management of acute and chronic compressive peripheral neuropathies have not kept pace with advances in our understanding of the pathophsiology of these disorders. In this review, the pathophysiological differences between acute and chronic compressive neuropathy are reviewed from experimental models as well as from clinical examples in humans. It is concluded that surgical intervention is unlikely to alter significantly the course of recovery in acute compressive neuropathies. Similarly, in chronic compressive neuropathies without progressive weakness, conservative treatment is indicated because of the high incidence of spontaneous improvement. However, in patients with progressive weakness, especially in conjunction with electrophysiological evidence of partial denervation or conduction block (but not simply slowing of nerve conduction), surgical treatment is recommended.