Neurological Spine Disorders

Peripheral Nerve Injury

What is the peripheral nervous system?

The peripheral nervous system consists of cranial nerves, spinal nerves, nerves of the arms and legs, and the cervical, brachial and lumbosacral plexi, which connect to the central nervous system.

What is a peripheral nerve injury and what causes it?

These nerves can sustain injury from a number of causes, including accidents or trauma. The injury can result in a minor injury or a fully severed nerve. Based on the type and amount of damage, nerve regeneration may or may not be possible. Treatment depends on the type of injury, symptoms and the amount of nerve injury sustained.

Nerves can also become entrapped or compressed. Certain nerves are more susceptible to this type of injury because of where they are located in the body. Common entrapment neuropathies include carpal tunnel syndrome, anterior interosseous neuropathy, ulnar nerve entrapment, and radial nerve, femoral nerve and peroneal nerve conditions. Some medical conditions may increase the likelihood of this injury, such as diabetes, hypothyroidism, acromegaly, amyloidosis, carcinomatosis, polymyalgia rheumatic, rheumatoid arthritis or gout.

What are the symptoms of peripheral nerve injury?

Symptoms of peripheral nerve injury may include pain in the affected area, burning sensations and numbness.

How is peripheral nerve injury diagnosed?

Diagnosis of peripheral nerve problems involves a medical history, physical examination and diagnostic tests.

What are the treatment options for peripheral nerve injuries?

Treatment of peripheral nerve problems are geared to reduce or eliminate symptoms. Nonsurgical treatments include medications, immobilization and physical therapy. Surgical treatment may be needed if the individual has persistent neurologic symptoms or if conservative therapies have been unsuccessful.

How are peripheral nerve injuries treated?

Carpal tunnel syndrome
Carpal tunnel syndrome is a problem that affects the wrist and hand. It often occurs as a result of repetitive motions like typing or writing. It can cause numbness, tingling, pain and weakness. Symptoms often wake the person at night and progress if not treated.

Carpal tunnel syndrome is treated with surgery to decompress the median nerve by cutting the ligament at the bottom of the wrist to release pressure. This is an outpatient procedure and you go home the same day. Your hand and wrist may be bandaged for seven to 10 days. Often the bandage stays in place until you visit the clinic for removal of the stiches.

You may or may not experience immediate relief, as the area will be sore following surgery. That will improve over time. Pain medication will be provided before you go home. It is recommended that you rest and elevate your hand and wrist, as well as limiting their use.

Ulnar neuropathy or cubital tunnel syndrome
Ulnar neuropathy or cubital tunnel syndrome affects the peripheral nerves at the elbow. It is often caused by direct pressure on the elbow’s ulnar nerve and can lead to numbness, tingling, pain and weakness. When conservative treatments are insufficient, ulnar nerve transposition is performed to decompress the nerve.

This surgery involves moving and padding the ulnar nerve to release pressure/irritation. This is an outpatient procedure and you go home the same day. Your elbow may be bandaged for seven to 10 days. Often the bandage stays in place until you visit the clinic for removal of the stiches.

You may or may not experience immediate relief, as the area will be sore following surgery. That will improve over time. Pain medication will be provided before you go home. It is recommended that you rest and elevate your arm, as well as limiting its use. Patients are often kept in a sling to minimize extension of the arm.

Brachial plexus injuries
Brachial plexus injuries are often caused by trauma, traction and or compression of the nerves involving the brachial plexus, a network of nerve fibers. With severe injuries, pain relief can be hard to achieve and chronic pain may result.

Dorsal root entry zone (DREZ) myelotomy surgery may be done to selectively destroy a portion of the spinal cord, where the sensory nerve root fibers enter the spinal cord. The outcome for those with severe, chronic pain is significant long-term pain relief and improved quality of life.

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