Neuro Spinal Hospital

When is Peripheral Nerve Surgery required?


The Nervous System functionally coordinates our bodyís actions. It consists of a Central Nerve System (CNS) and a Peripheral Nerve System (PNS). The CNS encompasses the brain and the spinal cord. The PNS is a complex network of enclosed bundles of long fi bres. The nerves connect the CNS to every part of the body. The sensory nerve fi bres pick up sensorial (visual, tactile, etc.) information from the distant organs (e.g. the eyes, the ears and those away from the brain like the limbs) and carry them to the CNS. In turn, the motor fi bres transmit signals from the brain to the various parts of the body to perform the action. For example, on seeing a fl ower, visual and olfactory information is conveyed to the brain that recognises it and consequently transmits messages to the arm and hand to perform the action necessary to pick the fl ower.

Peripheral nerves can be affected by pathologies (e.g. nerve injuries, entrapments and tumours) which may require surgery. Although nerves usually lie deep under the skin and muscles, they are exposed to physical damage. Nerve injuries occur in 25% of overall traumas. They can occur alone or be associated with other injuries (head injuries, spine injuries, bone fractures, etc.). A nerve injury results in the loss of sensory and motor function in the region (the skin and the underlying muscles) controlled by that nerve. For instance, a humeral fracture associated with a rupture of the radial nerve leads to a wrist drop.

Sometimes the trauma can damage the whole group of the nerves (brachial plexus) controlling the function of the upper limb, with various degrees of functional impairment, the most extreme being a fl ail arm. Such an event is likely to occur in adults after trauma such as motorcycle accidents, or in babies following a diffi cult delivery (Erbís Palsy). If the nerve damage is reversible, spontaneous recovery can occur, but should a nerve rupture be suspected, the only possibility to rescue the patient from severe disability is a surgical reconstruction of the nerve.

Other situations where nerves can be damaged include entrapment. Medical conditions consequent to the mechanical compression of a nerve include pain, numbness and tingling where the nerve is damaged. In the long run, if the mechanical compression is not relieved, the damaged nerve becomes unable to perform its specifi c function. Well known examples of entrapment syndromes are the carpal tunnel syndrome and ulnar nerve entrapment at the elbow. Less common entrapments are often not easily diagnosed by inexperienced physicians. For example, such is the case of thoracic outlet syndrome (TOS). This is the entrapment of the roots of the brachial plexus. Patients with TOS complain about severe pain radiating along the shoulder and the whole upper limb and associated with intense numbness and tingling especially on the last two or three digits of the affected hand. In entrapment syndromes, the surgeon relieves the compression on the nerves, providing relief from the painful symptoms.

Nerve tumours
Peripheral nerve surgeons are empowered with the technical skills necessary to remove nerve tumours. In most cases the tumour grows inside the nerve, displacing its fi bres or enveloping them within its mass. The surgeon identifi es and isolates the nerve fi bres to prevent the tumour, otherwise a palsy will be detected after the procedure. There is also a genetic disease (Neurofi bromatosis) associated with constant tumour growth along the nerves. Peripheral nerve surgeons should possess an excellent knowledge of neurology. Their experience and specifi c technical skills allow them to apply the best procedural strategy tailored for each case.



Date of upload: 22nd Nov 2017

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