PERIPHERAL NERVE SURGERY

WHAT IS PERIPHERAL NERVE SURGERY?

Peripheral nerve surgery includes the diagnosis and treatment of acute nerve injuries, entrapment neuropathies, nerve sheath tumors, and other diseases originating from peripheral nerves. Peripheral neuropathy, a result of damage to the peripheral nerves, typically causes weakness, numbness, and pain in the hands and feet. It can also affect other areas of the body.

HOW DOES THE PERİPHERAL NERVE SYSTEM WORK?

The primary function of peripheral nerves is to transmit signals from the spinal cord to the rest of the body and vice versa. For example, if we want to move our index finger, the command is sent from the brain to the spinal cord and then to the muscles that control the finger via peripheral nerves. This process happens instantaneously.

The sciatic nerve is one of the peripheral nerves and can be up to 1 cm thick. While the sciatic nerve is more visible, some peripheral nerves require a microscope to be seen.

Each nerve in the peripheral nervous system has a specific function, so symptoms vary depending on which nerves are affected.

WHAT ARE THE DISEASES AND SYMPTOMS OF THE PERIPHERAL NERVOUS SYSTEM?

Disorders and diseases of the peripheral nervous system can present as follows and are typically worse at night, seriously disrupting sleep:

•  Muscle weakness and cramps
•  Sensitivity to touch
•  Tingling, burning, twitching, or numbness that starts in the hands and feet and spreads upwards
•  Severe pain
•  Lack of coordination
•  Imbalance

Damage to motor nerves can cause cramps, pain, muscle weakness, twitching, muscle loss, and changes in skin, hair, and nails. Sensory nerve damage often results in numbness in the hands and feet, making it feel as if you're wearing gloves or socks when you are not.

PERIPHERAL NERVE SYSTEM DAMAGE AND RECOVERY PROCESS

Recovery from injuries to the brain and spinal cord is challenging and limited. Conversely, recovery from peripheral nerve injuries is more likely. With timely and proper intervention, a completely damaged peripheral nerve can be treated effectively without leaving any problems for the patient.

When a peripheral nerve is cut, it begins to degenerate from the distal end. This process is known as 'Wallerian Degeneration.' When the nerve is repaired, the healthy part of the nerve grows downward toward the degenerated part at a rate of approximately 1 mm per day, which is about 3 cm per month. Once the healing nerve reaches the muscle, movement resumes, though this process can take months and may result in muscle atrophy due to the extended recovery time.

Patients should be aware that recovery takes time and must remain patient and hopeful. Passive exercises can help prevent joint stiffness during the recovery process.

HOW IS TREATMENT PLANNED FOR PERIPHERAL NERVE ENTRAPMENTS?

There are two treatment approaches for entrapment neuropathies. Conservative treatment includes limiting movement in the affected area, maintaining a proper position, weight loss, using diuretics, local steroid applications, vitamins B6 and B12, and orthosis use.

If there is no improvement in clinical and electrophysiological findings despite conservative treatment, or if the patient's complaints persist, surgical treatment should be considered. The primary goal of surgery is to relieve the pressure on the nerve. Early surgical intervention is recommended in cases of unbearable pain and numbness.