In the agricultural setting, mononeuropathies can occur secondary to direct trauma, compression, stretch injury, ischemia, infection, or inflammatory disease. Especially common are the nerve entrapments with compression of the nerve either by normally present anatomical structures or by an external source. The most common nerve entrapments are at the median nerve of the wrist (carpal tunnel syndrome) and ulnar nerve of the elbow (cubital tunnel syndrome). Other mononeuropathies such as femoral (including lateral femoral cutaneous) and peroneal mononeuropathy are less commonly observed, while lumbosacral disk syndromes are exceedingly common but are best addressed in conjunction with aggressive pain management and surgical evaluation, a modality that requires team approach (38-41).
Compression and entrapment neuropathies are predominantly demyelinat-ing and result in slowing of the nerve conduction through the affected fibers. A complete block is observed in acute compression and is uncommon in the chronic presentation. Secondary axonal changes are expected in patients with unresolved compression or entrapment that leads to ischemia and nerve tran-section and are often irreversible as they may lead to both wallerian degeneration distally and changes in self-regulation of the neuronal networks at the spinal level, while simple demyelinating lesions typically have a better capacity to recover.
Nerve conduction studies (NCS) and EMG are extremely useful in defining the lesion location, the type of damage, and thus the prognosis. It is often necessary to test more than one nerve in any given extremity to avoid the misdiag-nosis of a mononeuropathy in a patient with polyneuropathic disease (42).
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