Peripheral Nerve Entrapment Self-Assessment

What the assessment covers

This is a pattern-recognition tool that maps the symptoms of non-surgical nerve pain to the peripheral nerve most likely to be trapped or irritated. It is built around the clinical patterns Dr. Alex Movshis, MD — a dual-board-certified anesthesiologist and pain medicine physician in Midtown Manhattan — uses to triage new-patient consults. It is educational. It is not a diagnosis. If your pain began after abdominal, pelvic, or breast surgery, the tool routes you to the post-surgical nerve pain self-assessment, which is built around the nerves that cross those operative fields.

Questions the assessment asks

The questions follow the history a pain physician takes at a first visit — location, onset, character, severity, timing, what makes it worse or better, radiation, what has been tried, medicines, and the patient's own question — grouped so related items share one screen. After the body map, every screen shows only the options that matter for the areas marked: a hip patient is not asked about hairbrushes or wrist bands.

1. Safety check (11 yes/no items). Screens for the emergencies that can hide behind these presentations — cauda equina syndrome, progressive weakness or a new foot drop, spinal infection, subarachnoid haemorrhage or a headache with a neurological change, local infection, severe or quickly worsening new pain in a patient with a cancer history, aortic dissection, and a fracture after a fall. Any positive answer stops the assessment and tells you to call 911 or go to the nearest emergency room.
2. Where it hurts, and which side. Twenty-two named territories grouped by body region — scalp and skull base, posterior shoulder, the patch beside the shoulder blade, a rib band, low back and upper buttock, deep mid-buttock, the sit bone, the perineum, the genitals, the area around the anus, the tailbone, the side of the hip, the front of the hip and groin, outer thigh, below the knee, the back of the hand and thumb, the palm — plus left, right, both, or midline, and a free-text description.
3. Pelvic-floor questions (only if a pelvic-floor area is marked). Bowel, bladder, and gynecologic warning signs — rectal bleeding, a lasting change in bowel habit or unexplained weight loss, abnormal vaginal bleeding or discharge, blood in the urine, a lump or sore — any of which sends the patient to that evaluation before a nerve is considered. Then the associated symptoms from the Nantes criteria for pudendal neuralgia: a foreign-body feeling in the rectum or vagina, pain after a bowel movement or with sex, and bladder symptoms.
4. Onset. Sudden or gradual, what came before it (surgery, a rib fracture, shingles, a head or neck injury, desk posture, overhead sport, long sitting or cycling, a tight watch, a wrist injury, tight waistbands, rapid weight loss including on a GLP-1 medication, pregnancy, a vaginal delivery, a fall), how long, and whether it is getting better, worse, or staying the same.
5. Character. Burning, painful cold, electric shocks, tingling, pins and needles, numbness, and itching — the seven patient-reported items of the validated DN4 nerve-pain questionnaire — plus aching, sharp, deep pressure, sensitivity to light touch, and the throbbing-with-nausea descriptor that separates migraine from occipital neuralgia.
6. Severity and impact. The PEG: average pain, and how much pain has interfered with enjoyment of life and with general activity over the past week, each on a 0–10 scale.
7. Timing. Constant, constant with flares, intermittent, or brief attacks lasting seconds, plus morning stiffness, building through the day, or waking at night.
8. Worse with, better with. Sitting, standing or walking, rising from a chair, hip extension, lying on the side, hip rotation, a deep breath, overhead reaching, wrist and thumb movement, anything tight over the area, a hairbrush or pillow, neck movement — and lying down, standing up, a toilet seat or cutout cushion, changing position, movement, heat, ice, pressure, or a moment of scratching.
9. Radiation and weakness. Stays in one patch, shoots up the scalp, wraps along one rib, spreads across the buttock, travels below the knee, or runs past the elbow into the fingers, and whether there is weakness — several of these nerves carry feeling only, so normal strength is itself a finding.
10. Tender-point self-test. The published entrapment landmarks for the areas marked, in plain language — below the skull base, the top edge of the shoulder blade, the patch itself, along one rib, the pelvic rim three inches from the spine, deep mid-buttock, the sit bone, the bony point on the side of the hip, just inside the front hip bone, and the thumb side of the forearm.
11. Workup and treatment so far. Tests and specialist evaluations (including the ones whose normal result is part of a pattern, such as negative facet or SI injections or a failed rotator cuff program), treatments tried, and whether anything helped.
12. Medicines and background. Current pain medicines by class, and the three things a pain physician needs before recommending an injection: a blood thinner or daily aspirin, diabetes, and an allergy to contrast, iodine, local anesthetic, or latex.
13. Your main question. Is this a nerve problem? Why has nobody figured this out? What treatments might help? Is this permanent? Will I need surgery?

Every answer lands on a one-page pre-visit summary, in the order a clinician reads a history, that the patient can print, save as a PDF, or paste into a patient-portal message for any doctor.

Conditions the assessment can identify

Based on the answer pattern, the assessment routes to one of sixteen educational outputs. Each names the peripheral nerve most likely involved, explains why the pattern is commonly missed, describes what an in-office evaluation involves, and links to the relevant Modal Pain service page, the underlying blog post, and the peer-reviewed literature.

• Occipital neuralgia. Shooting, electric pain from the base of the skull up one side of the scalp, with a scalp that stays tender between attacks — the patient who cannot wear a ponytail or lie on that side. The tender point below the occipital ridge reproduces it. Diagnosis follows the International Classification of Headache Disorders criteria, and the occipital nerve block is both a diagnostic test and the first treatment. Read the full post.
• Cluneal nerve entrapment. Low back and upper outer buttock pain with a Tinel-positive point about 7 to 8 cm lateral to the midline on the iliac crest, in a patient whose facet and SI joint workups came back negative. The pain does not cross below the gluteal crease in a radicular pattern. Read the full post.
• Meralgia paresthetica. A burning, numb patch on the front and outer thigh that never crosses the knee, with no weakness at all — the lateral femoral cutaneous nerve is purely sensory. Worse with standing, hip extension, and tight waistbands. The tender point sits just inside and below the front hip bone. Read the full post.
• Suprascapular nerve entrapment. Deep posterior shoulder pain with weak external rotation, regularly mistaken for a rotator cuff tear because the infraspinatus is the shared variable. Isolated wasting below the ridge of the shoulder blade with an intact cuff is the tell. Read the full post.
• Wartenberg's syndrome. Burning on the back of the hand, the thumb-side wrist, and the top of the thumb — never the palm, which is why it is not carpal tunnel. Triggered by a tight watch or fitness tracker; the Tinel point sits over the brachioradialis tendon about 9 cm above the wrist. Read the full post.
• Notalgia paresthetica. Itch more than pain, in a well-defined patch medial or inferior to one shoulder blade, driven by the thoracic dorsal rami rather than by any skin disease — which is why creams usually fail while capsaicin can help. Read the full post.
• Intercostal neuralgia. A band of burning pain along one rib space wrapping from the back toward the front, after chest surgery, a rib fracture, or shingles — with cardiac and pulmonary causes excluded first. Read the full post.
• Deep gluteal syndrome and piriformis syndrome. Deep mid-buttock pain that builds the longer you sit and eases on standing, with a positive FAIR test in office — separated from proximal hamstring tendinopathy and ischiogluteal bursitis, which are pinpoint tender right on the sit bone. Read the full post.
• Pudendal neuralgia. Burning or aching pain in the perineum, genitals, or around the anus that builds the longer you sit, eases on standing, hurts less on a toilet seat, and does not wake you at night — the patient-reportable half of the Nantes criteria. The other half, a normal sensory exam and relief from an image-guided pudendal nerve block, happens in office. Buttock pain that also reaches between the legs is routed here rather than to piriformis syndrome. Read the full post.
• Pelvic-floor pain outside the pudendal pattern. Pain that wakes you at night, pain confined to the tailbone, or perineal pain that is not worse sitting — each outside the Nantes pattern — gets an honest output that names the wider differential and the exam that sorts it.
• Pelvic warning signs first. Rectal bleeding, a change in bowel habit, abnormal vaginal bleeding, blood in the urine, or a lump routes to the matching organ evaluation before any nerve is named.
• Hip pain that is a joint or tendon, not a nerve. Pain over the bony point on the side of the hip, worse lying on it, is usually the gluteal tendons and bursa. Pain at the front of the hip or in the groin, worse with rotation and getting out of a car, is usually the hip joint. Neither is a trapped nerve, so the output says so and points to the hip bursitis and hip osteoarthritis pages — unless a real nerve pattern, such as meralgia paresthetica on the outer thigh, is also present.
• Post-surgical routing. Pain that began after abdominal, pelvic, or breast surgery is sent to the post-surgical assessment, which covers the ilioinguinal, iliohypogastric, genitofemoral, pudendal, obturator, intercostobrachial, and anterior cutaneous nerves.
• Radiculopathy routing. A dermatomal pattern below the knee or past the elbow into the fingers, together with a motor or reflex change, is a nerve root rather than a peripheral entrapment, and routes to the radiculopathy service.
• Indeterminate or mixed pattern. An honest output for answers that do not localize — including the discriminators patients most often blur, such as palm-plus-dorsum hand symptoms, and throbbing whole-head pain with nausea that is migraine physiology rather than one irritated nerve.
• Emergency department routing for any positive item on the safety check.

What evaluation involves at Modal Pain

The first visit pairs a focused in-office cutaneous exam — mapping the painful territory and testing the published entrapment points along the nerves that supply it — with an ultrasound-guided diagnostic block when the exam supports one. The block is the most useful single test: if numbing the suspected nerve switches off the familiar pain within 5 to 15 minutes, that nerve becomes the likely source. For a trapped nerve the test uses a small volume of local anesthetic alone. When it clearly relieves the familiar pain and the pain keeps coming back, the next step is usually referral to a surgeon who focuses exclusively on peripheral nerve entrapment, and surgeons look for a documented positive block before operating. Modal Pain Management is located at 369 Lexington Avenue Floor 25 in Midtown Manhattan. Same-week new-patient consults are usually available. The practice works with most commercial PPO insurance plans and does not accept Medicare, Medicaid, HMO plans, or workers' compensation. We check your benefits and go over what your plan covers and any expected cost by phone before your visit, so there are no surprise bills.

Privacy

Your answers are held in your own browser and cleared after 24 hours. This tool has no contact form and no server endpoint, so nothing you select is transmitted to Modal Pain. The pre-visit summary on the result screen is built in the same browser, and printing it, saving it, or copying it sends nothing anywhere. Anonymous usage analytics — which result screen was reached, never what you selected — may be recorded where privacy rules permit, and are disabled entirely for visitors in regions where consent has not been collected.