Peripheral Nerve Surgery
Introduction to Neuropathy and Polyneuropathy
Peripheral nerves are the nerves in the body found outside the central nervous system (brain and spinal cord). There are sensory nerves (transmitting sensation) and motor nerves (triggering movement) as well as mixed nerves. The sensory nerves transmit, for example, the sensation in our hands and feet and are sensitive to pressure, temperature change, movement and pain. Therefore, they are also responsible for tissue characteristics, temperature control, perspiration and fine tuning of blood circulation. If there is pressure on these nerves then there is a lack of oxygen in them and they can endure damage thus triggering abnormal sensations such as prickling, numbness or pain (neuropathy). These compression-damaged nerves can be operated on to relieve or even eliminate symptoms in what is called nerve decompression surgery.
Diabetes mellitus is a common cause of neuropathy (nerve damage). Apart from diabetes, neuropathy can be caused by hormone disorders, especially thyroid hormone imbalance, vitamin deficiency syndromes, alcoholism, heavy metal poisoning, leprosy, chemotherapy-related conditions and long-term dependence on a mechanical ventilator. The diagnosis is also frequently made as idiopathic neuropathy, meaning the cause is unknown.
If several nerves are affected then this is known as polyneuropathy. It is frequently assumed that this is surgically untreatable. On the contrary, even if symptoms have existed for many years, operative treatment makes improvement possible and realistic.
Nerve Compression Syndromes
Nerve compression syndromes usually appear at typical anatomical points in the body that are rather narrow by nature, thus giving the affected nerve no room to manoeuvre. This could be in a bony area with a tight capsular ligament over it, but there are countless other conditions that can lead to critical pressure on a nerve. For example, a scar, swelling near a tendon or joint, a ganglion or even a nerve tumour. It is also often a combination of these factors.
You will find descriptions on nerve compression syndromes of the upper-extremities in the hand surgery section:
- Carpal Tunnel Syndrome
- Pronator Syndrome
- Anterior Interosseous Syndrome
- Cubital Tunnel Syndrome
- Guyon’s Canal Syndrome
- Supinator Syndrome
- Wartenberg Syndrome
- "Park bench Paralysis" / Drophand
Here you will find information on nerve compression syndromes affecting the legs:
Partial Knee Joint Denervation – Dellon Method
We can offer a less well-known treatment method here in Germany to patients suffering from chronic knee-joint pain. Professor A.L Dellon (Plastic Surgery and Neurosurgery, Baltimore, USA) developed an operation to treat knee pain and has successfully been performing it since 1992.
Nerve Injuries caused by Accident or Operation
Injuries to nerve-end branches can also occur as a result of other injuries or operations, especially in certain foot and blood vessel operations because not every single nerve branch can be protected.
Groin Pain due to Injury or Nerve Compression
Nerves in the lower abdomen or flanks can transmit pain due to chronic pressure, scarring or injury.
When nerves are severed, for example, and cannot completely regenerate, there is a tendency for the nerve ends to develop small scars or knots. These knots (neuromas) are actually unsuccessfully sprouted nerve ends, which can cause considerable pain when touched, for example in the phenomenon of phantom pain after an amputation. Nerve injuries can also take the form of complications in routine operations, for example during varicose vein operations, in which the affected nerves could be sensory nerves such as the saphenous nerve in the thigh or the sural nerve in the calf.
Pain from neuromas actually only begins to appear a few weeks after the nerve injury occurred. The neuroma itself cannot simply just be removed due to the high risk of its reforming. If the end-to-end suturing of the nerve is unsuccessful, then there is also the option of sinking the nerve deep into the surrounding muscle (see section on nerve injuries). However, sensitivity disorders will permanently exist in this area, but generally, painful touch sensations are eliminated.
The above procedures also apply to nerve tumours such as neurofibromas or schwannomas (synonym: neurilemoma), which can spontaneously appear in the peripheral nervous system. These generally benign tumours can cause intense stabbing pains. Schwannomas often typically appear on the back of the extremities as well as on the head and neck. They characteristically just appear as a painless swelling. Neurofibromas behave in a similar way and tend to be found in the extremities or trunk of the body. Malignant forms are rare, but all parts of a tumour that are removed undergo histological examination.
The surgery of peripheral nerves and the treatment of chronic pain triggered by these nerves are key areas of the work we do at our practice. We will gladly advise and examine you should you identify any of the above as being related to your problems.