Peripheral Nerve Surgery

Carpal tunnel syndrome is the most common entrapment neuropathy, resulting from compression of the median nerve within the carpal tunnel at the wrist and causing numbness, tingling and pain in the thumb, index, middle and half of the ring finger. Treatment is graded by severity: conservative methods such as splinting and injection in mild cases, and carpal tunnel release surgery in resistant or advanced cases.

Cubital tunnel syndrome is the second most common entrapment neuropathy after carpal tunnel syndrome, resulting from compression of the ulnar nerve at the elbow and causing numbness in the ring and little fingers, hand weakness and, in advanced disease, muscle wasting. Treatment is graded by severity: conservative measures aimed at protecting the elbow in mild cases, and decompression or nerve transposition surgery in advanced cases.

Peroneal (fibular) nerve injury is a common peripheral nerve compression or injury of the lower limb. Its most prominent sign is 'foot drop', in which dorsiflexion of the foot (lifting the foot upward) cannot be performed. Treatment varies with cause and severity of injury; relieving compression, an ankle-foot orthosis (AFO), physiotherapy and, in selected cases, surgery (decompression, nerve or tendon transfer) are used.

Peripheral nerve tumors are a group of benign or malignant masses arising from the sheath cells of peripheral nerves (Schwann cells, perineural fibroblasts). The most common benign tumors are schwannoma and neurofibroma; malignant peripheral nerve sheath tumor (MPNST) is a rare but aggressive cancer. Treatment is essentially surgical; the prognosis is excellent for benign tumors but poor for MPNST.

Thoracic outlet syndrome (TOS) is a group of symptoms caused by compression of the brachial plexus, subclavian artery or subclavian vein in the narrow anatomical passage of the neck-shoulder region. The neurogenic type (nerve compression) is the most common; the arterial and venous types are rare. Treatment is usually conservative (physiotherapy, postural correction); in refractory or vascular cases, surgery (first rib resection, scalenectomy) is performed.

Morton's neuroma (intermetatarsal neuroma) is a benign thickening and fibrosis of the plantar digital nerve as it passes between the metatarsal heads in the forefoot. It is not a true tumour but a fibrous tissue proliferation caused by chronic nerve irritation. It most commonly occurs between the third and fourth toes and presents with burning, stabbing, electric shock-like pain in the forefoot. Treatment is initially conservative; in refractory cases, surgery or minimally invasive methods are used.