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Peripheral Nerve Management and Surgery
What are peripheral nerves?
The complexity of the human nervous system encompasses the brain and the spinal cord. Indeed, maladies of these two components make up the majority of what neurosurgeons treat. Nevertheless, there is one more important area of treatment- that is, the disorder of the peripheral nerves, cord-containing bundles of nerve fibers that carry information to and from the spinal cord. Functioning like telephone cables, peripheral nerves are enveloped by a tough outer layer surrounding discrete bundles of tiny fibers, or “axons,” each containing electrical signaling information. It is the delay, interruption, or misinterpretation of this signal that comprises the science of peripheral nerve surgery.
Peripheral nerve injury and healing
Unlike the central nervous system (which is made of the brain and the spinal cord), the peripheral nerves have the ability to regrow into an area of degeneration. This growth occurs at an average rate of 1mm/day. As this process occurs, a process that may take months to years to finish, the supplied muscle will weaken and atrophy. Advances in the rate of nerve regrowth are currently being studied. However, to this date no single technique has markedly improved upon mother nature’s rate of recovery.
Common peripheral nerve problems
CARPAL TUNNEL SYNDROME: this is one of the most common peripheral nerve disorders where the median nerve is compressed by an overlying ligament in the wrist area. This entrapment causes numbness in the thumb, index, and middle fingers.
ULNAR NERVE SYNDROME: also fairly common, ulnar nerve entrapment manifests as elbow pain and sensory loss of the little and ring fingers. It may be preceded by an elbow injury.
PERONEAL NERVE COMPRESSION: less common than the above two but potentially more devastating as this compression syndrome may lead to a foot drop that may require ankle bracing. Lower leg numbness and numbness on the top of the foot are also symptoms.
After evaluation with electrical nerve conduction studies and/or diagnostic imaging along with a detailed physical examination, the initial treatment modality includes bracing of the affected area and medication therapy such as non-steroidal antiinflammatories and/or “nerve pills,” such as neurontin. Avoidance of aggravating actions is also a mainstay of therapy.
When conservative management fails, the next step may be surgical. Each surgeon has his/her own reasons for surgery however it may be assumed that failure of conservative therapy, worsening neurologic function, and/or quality of life changes are all universal reasons to move forward with surgery. These days incisions can be made in a minimally invasive fashion with little or no scar formation. Furthermore, intraoperative magnification has improved surgical technique and efficiency. Very few peripheral nerve problems are considered emergencies and therefore careful evaluation in a stepwise, detailed fashion should be undertaken first.
LastUpdate: 2016-05-11 16:34:18