PERIPHERAL NERVE SURGERY
Peripheral nerves refer to all the nerves in the body that arise from the spinal cord and innervate the arms, legs, and trunk. This is in contrast to the cranial nerves which arise from the brain and innervate structures in the head and neck. Some of the more well-known peripheral nerves are the median nerve which is affected in carpal tunnel syndrome, and the brachial plexus, a large bundle of nerves that bridge the spinal cord in the neck to the important nerves supplying the arm and hand.
Peripheral nerve problems that may require surgery include trauma or injury, compression or entrapment, and tumors. Symptoms of peripheral nerve problems depend on the location and severity of the condition, but in general, these include pain, numbness, tingling, and weakness in the affected part. For nerve tumors, a mass can also be felt under the skin in some cases.
The diagnosis is made by history and clinical examination, and supported by electrodiagnostic and/ or imaging studies. Electrodiagnostic studies include nerve conduction velocity (NCV) and electromyography (EMG), tests which would tell us if the nerve is affected and to what degree. Imaging studies such as MRI scans are helpful in cases of nerve tumors and some cases of nerve injury.
Management of peripheral nerve lesions vary, with the following treatment options:
1. observation and follow-up – In some cases of familial syndromes such as neurofibromatosis, observation is an option for small nerve tumors that do not cause any symptoms.
2. medical treatment – Some entrapment neuropathies may be treated conservatively such as using hand splints for carpal tunnel syndrome.
3. surgery – Surgery is indicated for certain types of nerve tumors, nerve injury, and nerve entrapment.
4. radiation/ chemotherapy – This is reserved for malignant nerve tumors such as sarcomas.
Here are some of the more common peripheral nerve conditions that may require surgery:
Carpal tunnel syndrome (CTS)
Ulnar nerve entrapment at the elbow (UNEE)
Brachial plexus injury
Thoracic outlet syndrome
Peripheral nerve tumors |
