Peripheral Nerve Problems: Evaluation and Surgical Management

Overview:

The peripheral nervous system is made up of all the nerves that exit the brain and spinal cord. Neurosurgical problems involving the peripheral nervous system include chronic entrapment neuropathies (e.g. carpal tunnel syndrome and ulnar neuropathy), acute closed and open traumtic peripheral nerve injuries, tumors and other types of masses involving peripheral nerves, and a variety of diseases either directly or indirectly involving peripheral nerves.

Related Conditions:

Entrapment neuropathies (e.g. Carpal Tunnel Syndrome, ulnar nerve entrapment across the elbow); Traumatic nerve injuries (e.g. brachial plexus injury); Peripheral nerve masses (e.g. Schwannomas, neurofibromas, intraneural ganglion cysts); Peripheral neuropathies due to diseases (e.g Diabetes, vasculitis)

Symptoms:

Peripheral injuries and diseases can cause abnormalities in sensation (e.g. pain, tingling, hypersensitivity or numbness) and strength (e.g. weakness, paralysis) in the distribution of the involved peripheral nerves.

Causes:

The most common causes of peripheral nerve problems are entrapment and/or repetitive strain neuropathies and neuropathies due to medical conditions such as diabetes. The two most common types of entrapment neuropathy are carpal tunnel syndrome and ulnar nerve entrapment at the elbow. Trauma, either direct or indirect, can also lead to either closed or open peripheral nerve injuries. The brachial plexus is the major network of nerves in the neck connecting the cervical spine with the upper extremity that controls movement and sensation in the arms and hands. Injuries or tumors involving the brachial plexus may result in weakness or paralysis, loss of sensation, pain and deformities of the affected arm and/or hand. Other causes of peripheral neuropapthy include Lyme’s disease, HIV, alcoholism, fractures or dislocated bones, pressure from prolonged use of crutches or staying in one position for too long, tumors and other masses, bleeding in or around nerves, exposure to cold or radiation, and vascular or collagen disorders such as atherosclerosis, systemic lupus erythematosus, scleroderma, sarcoidosis, rheumatoid arthritis and polyarteritis nodosa.

Risk Factors:

Risk factors for developing entrapment neuropathies include repetitive motion, trauma, pregnancy, endocrine abnormalies such as diabetes, and certain genetic conditions such as tomoculus (i.e. hereditary nerve pressure palsy).

Diagnosis:

Peripheral nerve problems are best diagnosed by: A thorough clinical history with a description of symptoms; a thorough physical peripheral nerve examination to elicit any signs; electrodiagnostic testing which usually includes electromyography (EMG), nerve conduction studies, and may include somatosensory and motor evoked potential studies; and radiological imaging studies which may include magnetic resonance imaging (MRI), computed tomography (CT) and myelography, and standard xrays.

Complications:

Undiagnosed and untreated peripheral nerve problems can lead to further loss of function with the development of additional painful sensations.

Treatment:

Peripheral nerve problems often require that patients perform physical therapy following medical and/or surgical treatment both formally with a physiatrist and on their own to preserve and improve function.

Contact Us:

Patients with Peripheral nerve questions can call 206-598-5637.

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