Carpal tunnel syndrome is just one condition that can affect the peripheral nervous system. Like electrical cords, 43 pairs of peripheral nerves extend from the spinal cord and enable movement, motor coordination and sensation throughout the body. Show
The pain, tingling, numbness and other discomforts of peripheral nerve disorders can often be treated successfully with physical therapy and other nonsurgical methods. But in some cases, surgery offers the best chance of lasting relief. How can you tell the difference? Neurosurgeon and peripheral nerve expert Allan Belzberg, M.D., explains. Common Peripheral Nerve Problems that May Need Surgery“The most common peripheral nerve injuries are caused by entrapment,” Belzberg says. “The nerves get trapped and compressed by shortened or thickened surrounding tendons, ligaments and other support structures.” He says carpal tunnel syndrome is the most common problem of this type, followed by:
Belzberg says that for these entrapments non-surgical treatment usually comes first. But if exercise, splints and anti-inflammatory medicines don’t resolve the problem, he explains that surgery may be necessary to enlarge the “tunnels” of ligament and tendon surrounding a peripheral nerve. “Nerve entrapment responds very well to surgery. The recovery is quick and people can get back to their regular activities.” Complex Peripheral Nerve Injuries that May Need SurgeryLess common — and more complex — are peripheral nerve injuries due to nerve tumors or trauma. These often require surgery. “In the U.S., we see peripheral nerve injuries caused by high speed motorcycle, car, snowmobile and all-terrain vehicle accidents, as well as falls,” Belzberg says. “The nerves can be stretched, cut or torn.” One area likely to be hurt in a high-velocity crash is the brachial plexus—the branches of nerves that emerge from the spinal cord at the neck and pass through the shoulder into the arm and hand. Damage to the brachial plexus, if not treated successfully, can leave a patient with lasting, severe pain and disability. Belzberg says, “Tumors, such as schwannomas and neurofibromas, can form along a nerve anywhere in the body. Fortunately, most of the time these tumors are benign and can simply be watched. They can also be associated with genetic disorders. Other times, they can grow and cause problems for the nerve or surrounding structures.” Although Belzberg’s particular area of expertise is nerve tumors involving the spine, he works with a team of expert surgeons to remove these tumors from virtually any place in the body where they might occur. A Multidisciplinary Approach to Peripheral Nerve SurgeryWhether addressing a compression, traumatic injury or nerve tumor, peripheral nerve surgery demands high skill and expertise — along with finely-tuned cooperation with other specialists. Belzberg notes that the Johns Hopkins Peripheral Nerve Surgery Center offers patients a multidisciplinary approach, combining the expertise of orthopaedics, plastic and reconstructive surgery, physical medicine and rehabilitation, and neurology, as well as neurosurgery. Experts in advanced imaging help Belzberg and his colleagues home in on the exact nature of the nerve injury to support effective surgery. Belzberg also notes that ongoing research helps his group develop more advanced approaches to peripheral nerve repair. A considerable amount of his time and effort is directed at basic and translational science, where he collaborates and directs numerous ongoing projects. “Through research, we’re learning more every day about how to help nerves regenerate and grow back. Our surgeons go back and forth between the operating room and our laboratories, bringing critical questions to the laboratory bench and taking cutting-edge knowledge and techniques back to the patient. That puts our expertise on the forefront, which benefits our patients.” An Innovative Approach to Nerve Repair | Santi’s Story
Santi's sciatic nerve was severed in a boating accident, paralyzing his right leg. He and his family traveled from Texas to Baltimore, where they met with neurosurgeon Allan Belzberg and orthopaedic trauma surgeon Greg Osgood. Together, the two surgeons collaborated to offer a novel way to repair Santi's leg and get him back to the water. If your doctor suspects you may have a form of peripheral neuropathy, they may refer you to a neurologist, a doctor who specializes in diseases of the nerves. The neurologist (or your own doctor) will begin by taking a history of your symptoms and
examining you for signs of muscle weakness, numbness, and impaired reflexes. You may need blood and urine tests to check for diabetes, vitamin or metabolic deficiencies and the presence of any underlying disease or genetic defect that may be affecting nerve function. Chemotherapy is a common cause. You’ll also need to take a serious look at your alcohol intake and what
medications you are taking. You may also be given an electromyogram (EMG) and nerve conduction velocity (NCV) tests, which is used to assess nerve and muscle function and measure the electrical properties of the nerves. Using these tests, doctors can often pinpoint the abnormal nerves and determine which part of their structure is damaged. Nerve and muscle
biopsies may also be performed and may provide valuable information about the type and cause of the neuropathy. A umbar puncture, known as a
spinal tap, is sometimes recommended to help identify infection or inflammation that might be associated with the neuropathy. If anyone in your family has been diagnosed with peripheral neuropathy or has had similar symptoms, your doctor may want to review their medical records or examine them to look for potential hereditary links to your condition. Effective prognosis and treatment of peripheral neuropathy relies heavily on the cause of the nerve damage. For example, a peripheral neuropathy caused by a vitamin deficiency can be treated -- even reversed -- with vitamin therapy and an improved diet. Likewise, nerve damage brought on by alcohol abuse can often be stopped and improved by avoiding alcohol. Peripheral neuropathy caused by toxic substances or medications can often be corrected in much the same way. When neuropathy is related to
diabetes, careful monitoring of blood sugar levels may slow its progression and curb symptoms. Early diagnosis and treatment of peripheral neuropathy is important, because the peripheral nerves have a limited capacity to regenerate, and treatment may only stop the progression -- not reverse damage. If you have become severely impaired, you may need physical therapy to help retain strength and avoid muscle cramping and
spasms. Medications to control symptoms include duloxetine (Cymbalta), gabapentin
(Neurontin), pregabalin (Lyrica), or some antiepileptic medications Surgical treatment may be recommended for people with nerve damage from
injury or nerve compression. Mobility aids, such as a cane, walker, or wheelchair, may be helpful. For pain, your doctor may prescribe pain medication. How Can Peripheral Neuropathy Be Prevented?Some forms of peripheral neuropathy can be averted by maintaining sound health habits. Eating a nutritious diet, exercising regularly, and abstaining from excessive alcohol consumption can all help prevent nerve damage. Avoiding injuries and toxic chemicals and carefully managing underlying disorders, such as diabetes, can also help prevent peripheral neuropathy. Can nerve damage in foot be cured?There is no cure for peripheral neuropathy but proper treatment will slow progression and address your symptoms. If the cause of the foot neuropathy is known, then treatment of the underlying cause may provide relief.
What can I do about nerve damage in my feet?To help you manage peripheral neuropathy:. Take care of your feet, especially if you have diabetes. Check daily for blisters, cuts or calluses. ... . Exercise. ... . Quit smoking. ... . Eat healthy meals. ... . Avoid excessive alcohol. ... . Monitor your blood glucose levels.. How long does nerve damage in foot take to heal?Nerves typically grow about an inch per month, and once the insulating cover is repaired, the nerve will usually begin to heal three or four weeks afterwards. A nerve injury in the ankle above the toes may take up to a year to return feeling to the toes.
How do you know if your foot has nerve damage?Symptoms of peripheral neuropathy
numbness and tingling in the feet or hands. burning, stabbing or shooting pain in affected areas. loss of balance and co-ordination. muscle weakness, especially in the feet.
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What can be done for nerve damage in foot
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