DeNigris was working out in a gym when he bent over
a bench with his knees locked. A burning pain shot from
the bottom of his right foot up to his buttocks and
then went away.
Mr. DeNigris's story ended there, it might have been
a cautionary "lesson learned" for other weight
lifters. But five years after the gym incident, the
pain returned--never consistently, but with a vengance.
days I had numbness in the toes, other times it was
a sharp feeling in the ankle or the heel," says
Mr. DeNigris. "But never did a day go by that I
didn't cringe in pain."
hurt so much to walk, run, or play with his three young
children that he began taking six Advil at a time, with
little relief. Neurotin was also prescribed and provided
at least some relief so he could get some sleep, otherwise
3-4 hours was all he could get before waking up in pain.
the next two years, the Rhode Island man went from one
doctor to the next looking for answers. His right ankle
was operated on because one specialist thought perhaps
a bone defect close to the sciatic nerve, which travels
from the thigh down to the foot, needed to be "cleaned
up to relieve pressure." The procedure was, in
Mr. DeNigris's mind, "a waste of time."
about one year ago, a neurologist ordered a high-resolution
MRI of Mr. DeNigris's right hip and thigh, and there
was the answer: a golf-ball sized tumor on the sciatic
nerve. Schwannomas, the type of tumor he had, grow on
the nerve sheath, or covering, and are often benign.
Nonetheless, they can be painful and cause weakness
or sensory changes.
DeNigris's doctors in Rhode Island recommended exploratory
surgery, but he wanted the schwannoma removed. He did
research on the Internet and sent e-mails to some neurosurgeons
who specialized in peripheral nerve surgery. Dr.
Allen Maniker, director of The Peripheral Nerve
Center- Neurological Institute of New Jersey at University
Hospital, was one of the doctors who answered back.
Mr. DeNigris was willing to travel three hours to Newark
partly because he's a native New Jerseyan with family
still in the state, but also because "to Dr. Maniker,
my case was routine."
are very slow growing and usually benign," says Dr.
Maniker, a board-certified neurosurgeon and fellowship
trained specialist in peripheral nerve surgery, "and,
as Mr. DeNigris experienced, they can be very painful.
Surgical removal of schwannomas has a 95 percent success
rate, usually causing no neurological deficit. While
schwannomas can grow large enough to be felt during
an exam and can be viewed using MRI, a final pathology
on the tumor after the operation confirms the diagnosis."
photo above illustrates a tumor on the leg. This
tumor was removed entirely and the patient regained
normal sensation and motor strength in his foot.
After the surgery, Mr. DeNigris had some minor post-operative
discomfort, but he was able to go home the next day.
the recovery period, I haven't had one twinge or inkling
of pain," says Mr. DeNigris. "I work out at
the gym three times a week and can play with my children.
It's as though I never had a problem."
are one of many conditions that can affect the peripheral
nervous system, the nerves that carry messages between
the body and the brain.
these diseases and disorders can be successfully treated
with medical management, while in other cases surgery
is necessary. Whichever course is appropriate, the Peripheral
Nerve Center at University Hospital has the expertise
to evaluate and treat a wide range of peripheral nerve
people are familiar with carpal tunnel syndrome, an
entrapped nerve disorder that affects the wrist.
The median nerve that runs through the wrist becomes
pinched by inflamed tendons adjacent to the nerve, causing
pain and numbness in the hand. Wearing a brace at night
and taking anti-inflammatory drugs helps relieve the
pain for some patients; others need surgery to take
the pressure off the nerve.
pain, often described as a burning, stabbing, or shooting
pain, is caused by "firing" of damaged nerves.
Diabetes accounts for about one-third of neuropathic
pain cases; other conditions where neuropathic pain
occurs include multiple scelrosis and "phantom
limb pain" caused by amputation.
type of tumor, neurofibromas, grow on the fibers of
the nerves. "Unlike schwannomas, which are found
in the general population, neurofibromas most often
are part of a genetic disease called neurofibromatosis,"
says Dr. Maniker. "Another significant difference
is that neurofibromas can become malignant."
Because of this possibility, and that they can
sometimes be painful, neurofibromas are either removed
surgically or treated with radiation.
diagnose a peripheral nerve disease or disorder, it's
important for the doctor to see images of the nerves.
With traditional MRI, it is difficult to discern between
peripheral nerves and soft tissue. The Peripheral Nerve
Center uses MRI neurography, essentially MRI with special
software, to produce cross-sectional images of the nerves.
study, electromyography, measures muscle contractions
in response to electrical stimulation of the nerves.
Dr. Denise Campagnolo is head of electromyography for
the Peripheral Nerve Center.
nerves, like any part of the body, can be affected by
trauma. Motor vehicle accidents (particularly those
involving motorcycles), electrical burn injuries, gunshot
wounds, and cutting incidents with chainsaws or knives
can sever or tear the nerves to varying degrees.
nerves can be torn from the spine, torn but not where
they are attached to the spine, or damaged but not torn.
often happens during a motorcycle accident, for example,
is that when the bike goes down, the rider's arm is
dragged behind," says Dr. Maniker. "This pulls
on the nerve roots and injures the brachial plexus,
the nerves that extend from the neck and control arm
and hand movement."
repair of peripheral nerves depends on the injury. A
patient whose peripheral nerves are severed in a jagged
fashion, by a gunshot wound, for example, does not immediately
have them repaired successfully.
Those nerve ends
are identified, and in about two weeks, the neurosurgeon
comes back to see how well they have healed. The portions
that haven't recovered are removed, and healthy nerves
from another part of the patient's body are grafted
does the neurosurgeon determine nerve function? One
assessment tool available at University Hospital is
intraoperative nerve action potential. During surgery,
nerves can be stimulated to determine if they respond
with an electrical signal.
palsy and Klumpke's palsy, two brachial plexus conditions
found in infants are, in effect, birth traumas.
there's a breech birth, a forceps delivery, or even
a very large baby, there's potential for injury to the
brachial plexus as the baby descends through the birth
canal," says Dr. Maniker. "Erb's palsy refers
to trauma to the nerves of the upper brachial plexus
-- the C5 and C6 roots -- and Klumpke's palsy affects
the lower brachial plexus at the C8-T1 roots."
Erb's baby could have paralysis or weakness in the upper
arm, while the hands are affected in Klumpke's infants.
95 percent of the time, says Dr. Maniker, the injured
nerves will heal well enough on their own within a few
months, and the child will have normal to near-normal
use of the arm or hand. Physical therapy exercises are
prescribed to keep joints supple during those months,
he notes, but don't necessarily improve the underlying
condition. If there is no improvement by the time the
child's first birthday, surgery is recommended to repair
that point, the choices for the parents are possible
recovery through surgery or to have a child with a totally
non-functioning arm or hand. The window of opportunity
for spontaneous recovery is closed," says Dr. Maniker,
one of the few neurosurgeons nationally who specializes
in the treatment of Erb's and Klumpke's palsies.
the operation, which takes between 4-5 hours, the brachial
plexus is exposed and the nerves are tested for electrical
signals. "Dead" nerves are removed and replaced
with nerves from other parts of the body. The surgery's
success takes between one year to 18 months to determine,
as nerves regenerate at about one inch per month.
a parent's perspective, it's difficult to watch their
baby be unable to move their hand or arm," says
Dr. Maniker. "But when the surgery is successful,
it opens a new world for both the child and his or her
contact the Peripheral Nerve Center, call (973) 972-2908,
or visit our web site at: