Jonathan Cheng, M.D. Answers Questions On: Peripheral Nerve Conditions and Disorders

Plastic surgeons bring a unique, specialized perspective to nerve conditions.

A fundamental part of plastic surgery is learning to perform complex reconstruction all over the body, from head to toe. This requires a mastery of anatomy and techniques for precise handling of the body’s tissues, including microsurgery to borrow from healthy areas of the body to repair distant injured areas.

Some plastic surgeons build upon this foundation of complex reconstruction by completing super-specialized training through a peripheral nerve fellowship. This training prepares them for the surgical care of peripheral nerve conditions: nerve injuries, nerve tumors, and nerve compression.

As an expert in this area, I have had specialized training in peripheral nerve surgery beginning in 2002 during medical school and through my residency and, ultimately, fellowship, which was completed in 2007. From then up to the present, I am constantly learning and evolving new and updated techniques and strategies.

I perform all types of peripheral nerve surgery on both adults and children.

There are four areas. First, compression neuropathy is when a nerve becomes compressed, or entrapped, between two other structures in the body. Often, the nerve is compressed beneath a ligament or band of fibrous tissue. Compression neuropathy includes carpal and cubital tunnel syndrome, lower extremity nerve compression syndromes, and even migraines.

Nerve injury is another area of nerve surgery. A nerve injury is when a nerve is stretched, torn, or cut due to trauma or surgery. In this case, reconstruction of the injured nerve may consist of nerve repair, nerve graft, nerve transfer, or tendon or muscle transfers to replace the patient’s missing functions.

Next, we have surgery to treat nerve-related pain. For example, if an injured nerve is causing pain, it could be repaired, cut or disconnected, or redirected into a neighboring muscle in order to reduce painful sensations.

Nerve tumors are the fourth area of nerve surgery. Nerve tumors are abnormal masses that grow on or in peripheral nerves. Most nerve tumors are benign and may be treated with surgery. The goal of surgery is usually to reduce or remove the tumor while minimizing damage to surrounding healthy tissue and nerves.

I perform these surgeries in addition to hand surgery and microsurgical reconstruction.

Nerve compression syndromes typically affect people who are naturally predisposed to develop these disorders. The most common one is carpal tunnel syndrome, which is worsened by repetitive hand use.

Cubital tunnel syndrome affects the ulnar nerve, which is the one that gives you that “funny bone” feeling at the elbow. You can get this type of injury from spending lots of time with the elbow bent or from resting on the elbow for long periods of time.

Tarsal tunnel syndrome affects the nerves at the ankle that give you feeling on the bottom of the foot. This type of disorder is common among people with diabetes.

Splinting and rest actually work quite well for people with mild carpal tunnel syndrome. For severe cases, we still try splinting first. If the patient already has weakness in the hand and loss of feeling, I will usually do a surgical release. This might be using a classic open procedure, or we can do minimally invasive work through a special camera.

My philosophy is to try to avoid surgery and allow the body to heal itself when possible.

For people with nerve compression problems, posture is a big issue. Bad posture is very common among computer users, especially those who use laptops. I recommend a workspace evaluation by a professional who can make recommendations on monitor, keyboard, mouse, and chair placement.

I also suggest getting up from the desk and walking for five to 10 minutes every hour to change position and relieve the stress on the arms and wrists. I ask my patients to work with a hand therapist to optimize these areas.