Peripheral Nerves

The Peripheral Nerve Evaluation and Treatment Center continues to expand under the direction of Dr. Michel Kliot. This center pools the resources of physicians and other caregivers in the fields of neurological surgery, rehabilitation medicine, neurology, pain management, pathology, oncology, and orthopedic surgery in order to optimize the care of patients with clinical problems involving the peripheral nervous system. Improvements in the diagnosis and surgical or medical treatment of peripheral nerve disorders are being pioneered at the University of Washington, employing high resolution magnetic resonance imaging (MRI) techniques and electrophysiological studies (EMG, nerve conduction). In addition, Dr. Kliot has an active laboratory research program directed at understanding the biology of peripheral nerve injury and recovery that complements his clinical practice.

For more information on peripheral nerve problems and treatments, please read the following primer:

The peripheral nervous system is made up of all the nerves that exit the brain and spinal cord. Thus, neurosurgical problems of the peripheral nervous system include peripheral neuropathies (carpal tunnel syndrome and ulnar neuropathy), brachial plexus injuries, nerve sheath tumors (neuromas and schwannomas) and trauma to the nerves of the body.

Peripheral neuropathies include several types of problems associated with nerves outside of the brain and spinal cord. These problems can cause pain, tingling, hypersensitivity or numbness in the arms or legs. The most common cause of peripheral neuropathies is due to repetitive use injuries. Examples of this are carpal tunnel syndrome and ulnar nerve entrapment. Diabetes, Lyme’s disease, HIV, alcoholism, mechanical pressure (compression or entrapment), direct trauma, penetrating injuries, contusions, fractures or dislocated bones, pressure involving the superficial nerves (for example, ulnar, radial, or peroneal nerves which can result from prolonged use of crutches or staying in one position for too long), tumors, 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, can all cause peripheral neuropathies. Many cases have no known cause, and thus physicians prescribe any number of different therapies to patients suffering from peripheral neuropathies. Patients experiencing peripheral neuropathy as a result of diabetes can often alleviate their condition by controlling the diabetes. When a tumor or ruptured disc causes neuropathy, therapy may require surgery to remove the tumor or to repair the ruptured disc. In many other cases, peripheral neuropathies can be relieved through therapy for some other disease.

The brachial plexus is the major network of nerves that controls movement and sensation in the arms and hands. Injuries or tumors of this structure or the nerves that make up the brachial plexus may result in weakness, including paralysis, loss of sensation, and deformities of the affected arm and/or hand. Surgical treatment of these problems, if warranted, may require removal of the tumor or scarred nerves and reconstruction of the brachial plexus using nerve grafts from other parts of the body. Sometimes, surgery cannot repair the brachial plexus, and permanent loss of function may result.

Tumors of the peripheral nervous system may arise from the sheath that surrounds the nerve, the nerve itself, or the connective tissue within the nerve. These tumors are generally benign and do not spread throughout the body. Some people have a genetic tendency to develop these tumors, especially those people with neurofibromatosis.

Trauma to the peripheral nervous system includes stab wounds or lacerations of the brachial plexus, the arms, hands, fingers, legs and neck. These problems may result from accidents or may occur when a tumor involves the nerves and must be removed. In these cases, surgery to repair the injured nerves may help; recovery, however, is slow, and requires rehabilitation and physical therapy. In general, peripheral nerves heal very slowly, at the rate of 1 inch a month. For example, if the ulnar nerve (the funny bone) is cut at the elbow, it may take up to 16 months for the nerve to heal all the way to the thumb (since the distance from the elbow to the thumb is about 16 inches, or 40 cm).

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