Peripheral Nerve CenterDisorders/Treatment Options Printer Friendly Page

Schwannomas

These tumors, often benign and slow growing, are found on the nerve sheath, or covering. They may affect any nerve within the body causing weakness, pain or sensory changes. Schwannomas can be surgically removed, and with today’s technology and procedures, often without damage to the nerve.

FIGURE 1 This is a patient who felt a lump in his leg and was beginning to have weakness and numbness of his foot. The patient is lying face down and the lump is outlined with the incision that will be made.

FIGURE 2 The tumor is exposed (2). This tumor was removed entirely and the patient regained normal sensation and motor strength in his foot.

Neurofibromas

Neurofibromas are tumors of the nerve fibers. Because they are located near the skin, there may be painful swelling. Neurofibromas can occur individually, but when there are many of them together, are often are part of a genetic disorder known as neurofibromatosis. There are two types of neurofibromatosis: Type I, or von Recklinghausen’s disease, and the rarer but more severe Type II. Neurofibromas can be surgically removed or reduced in size with radiation.

The brachial plexus is a group of nerves that extend from the neck and both sides of the upper thoracic (chest) spinal column. These nerves control the arms and hands. There are many conditions that involve the brachial plexus, from injuries that occur during the birth process to pinching or compressing of the nerves.

Erb’s palsy

A breech birth, a large baby, or the position of the baby’s shoulders in the birth canal can result in damage to a newborn’s brachial plexus. The degree of injury can be relatively minor–the nerves are damaged but not torn–to a complete tearing of the nerve from the spine. With Erb’s palsy, injury to the C5 and C6 roots of the brachial plexus causes paralysis to the upper arm.

Range-of-motion exercises are prescribed for these babies, and most of them–about 80% to 90%–will regain normal or near normal function of their arms. However, if significant bicep function isn’t detected when the baby is about 3 months old, surgery is often recommended. There are different procedures available, such as using nerves from other parts of the baby’s body to repair the damaged ones, or removing scar tissue from the nerves to improve function. If the early surgery isn’t successful, a tendon transfer may be attempted, generally before the child is 7 years old.

Klumpke’s palsy

Klumpke’s palsy, like Erb’s, results from damage to the brachial plexus during a difficult birth. When the baby’s arm is pulled in an upward motion during delivery, the lower roots can be injured, causing paralysis in the hand. The baby’s shoulder and elbow muscles are usually not affected. Horner’s syndrome, where one side of the face "droops" due to paralysis, may also be present. As with Erb’s palsy, exercises, evaluation of function, and surgery are common in the baby’s early months.

Brachial plexopathy

Damage to the brachial plexus is most commonly caused by traumatic injury, but can also be due to local radiation treatments, such as for lung cancer, or pressure from tumors near the area. On occasion there is no identifiable cause. The symptoms of brachial plexopathy include shoulder pain, numbness, a burning/tingling sensation, or weakness in the arm or hand.

Sometimes these injuries resolve themselves over time. Treatment includes pain relievers and physical therapy exercises. If a tumor is present at the site or tests reveal an entrapped nerve, surgery may be necessary.

FIGURE 3 This is an exposure of the entire brachial plexus. The patient’s head is to the right and the arm is off to the left. This illustrates the complexity of the nerves that form the brachial plexus that allow for complete movement of our arm and hand.

Thoracic outlet syndrome

When the brachial plexus becomes compressed by a rib or a fibrous band of tissue, the condition is known as thoracic outlet syndrome. The symptoms of thoracic outlet syndrome include pain, numbness, and/or tingling in the neck and shoulder and weakness in the hands.

Improved posture and exercises to strengthen the neck and shoulders are beneficial to some patients. However, in other cases, surgery may be needed to remove the rib or tissue that is causing pressure on the brachial plexus.

Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) occurs when the median nerve that runs through the wrist becomes entrapped, or pinched, by inflamed tendons adjacent to the nerve. This injury is commonly associated with repetitive motions such as excessive keyboard use, but it can also be triggered by fluid retention during pregnancy, rheumatoid arthritis, and other conditions.

Symptoms of CTS include pain and numbness in the hand –especially the thumb and first two fingers–that worsens at nighttime. The treatment for CTS often begins with the patient wearing a brace at night that takes pressure off the median nerve. Anti-inflammatory drugs, such as ibuprofen and aspirin, and cortisone injections at the affected site can help decrease the swelling. When these therapies are ineffective, surgery becomes an option. The surgeon relieves pressure on the nerve by cutting the ligament at the base of the wrist. If there is CTS in both wrists, the operations are done on one side at a time.

FIGURES 4 and 5 This is a patient who began to have pain and numbness in the thumb and first finger of her hand. Electromyographic studies revealed that the median nerve of the hand was being compressed in the carpal tunnel, where the nerve enters the wrist. The incision is outlined (4) and the nerve, after the carpal tunnel is opened, is exposed (5). The patients pain and numbness resolved.

Tarsal tunnel syndrome

When the posterior tibial nerve that passes near the ankle becomes entrapped, the condition is known as tarsal tunnel syndrome (TTS). The nerve travels through the tarsal tunnel, which has ankle bone on one side and a fibrous band of tissue on the other.

TTS, which is most commonly found in active adults, causes numbness and pain in the sole of the foot. Resting and elevating the foot, wearing arch supports, and taking anti-inflammatory drugs can provide relief. When these measures are ineffective, surgery may be recommended to cut a ligament and release the entrapped nerve.

FIGURE 6 This patient, a salesperson who was on her feet many hours of the day, had severe pain through the sole of her foot and into the underside of the toes. Electromyographic studies confirmed that the tibial nerve was trapped within the tarsal tunnel. The incision is outlined (6). Once the nerve was released, her pain resolved.

Cubital tunnel syndrome

Sometimes the "funny bone" doesn’t give people much to laugh about. Cubital tunnel syndrome occurs when the ulnar nerve becomes entrapped at the elbow. This condition can develop because of repetitive use of the elbow, arthritis, or trauma involving the elbow. Symptoms of this syndrome include weakness, pain, and numbness in the hand or elbow.

Resting the elbow can provide relief, as well as wearing a splint and taking anti-inflammatory drugs to reduce swelling. The surgical options are either to cut the bone that is pinching the ulnar nerve or to move the nerve from the cubital tunnel.

Meralgia paresthetica

The thigh’s lateral femoral cutaneous nerve can become entrapped, causing numbness or tingling in the outside of the thigh and at the hip. In more advanced cases, there may be sharp, shooting pain and a "burning" feeling at the site.

Meralgia paresthetica is associated with obesity, but it is also found in people who wear restrictive clothes or athletes that repeatedly extend their hips. Heavy patients may be advised to lose weight and do exercises to strengthen stomach muscles. Rest can be helpful, as well as taking anti-inflammatory drugs. This condition usually improves with time and non-surgical measures, but in unrelenting cases, an operation may be needed to release the entrapped nerve.

Nerves can be cut or bruised as a result of a trauma, and the type of injury determines the course of treatment. Some overly stretched nerves heal on their own over a course of a few months; nerves damaged by burns may require nerve grafting; and lacerated nerves may be able to be sutured together, depending on the cut’s severity.

FIGURE 7 This patient had fallen through a glass door in an accident, and a shard of glass lacerated his arm. He immediately lost sensation on the top of his hand and was unable to move his wrist in an upward direction. The lacerated nerve is seen at operation(7).

FIGURE 8 Nerve was harvested from another part of the body and used to fill in the gap of the lacerated nerve (8). The patient made a full functional recovery.

Then someone drops a bowling ball on their foot, the source of pain is easy to identify. It’s not always so simple to pinpoint the cause of neuropathic pain or to treat it, either. The body’s nervous system itself sometimes generates pain, whether due to an automatic "firing" of damaged nerves or another interruption to its normal function. Some of the medical conditions associated with neuropathic pain include diabetes, multiple sclerosis, and amputation ("phantom limb" pain).

Neuropathic pain is often described as burning, stabbing, and shooting, and over time, it can become disabling. The treatment for neuropathic pain varies, but includes nerve blocks, topical capsaicin cream, relaxation techniques, and medication.

Return to Top

Printer Friendly Page