Carpal tunnel syndrome is just one condition that can affect the peripheral nervous system. Like electrical cords, 43 pairs of peripheral nerves extend from the spinal cord and enable movement, motor coordination and sensation throughout the body.

The pain, tingling, numbness and other discomforts of peripheral nerve disorders can often be treated successfully with physical therapy and other nonsurgical methods. But in some cases, surgery offers the best chance of lasting relief. How can you tell the difference? Neurosurgeon and peripheral nerve expert Allan Belzberg, M.D., explains.

Common Peripheral Nerve Problems that May Need Surgery

“The most common peripheral nerve injuries are caused by entrapment,” Belzberg says. “The nerves get trapped and compressed by shortened or thickened surrounding tendons, ligaments and other support structures.”

He says carpal tunnel syndrome is the most common problem of this type, followed by:

• Ulnar nerve compression (affecting nerves in the arm)
• Peroneal nerve compression in the knee (including foot drop)
• Meralgia parasthetica, which affects peripheral nerves in the thigh
• Tarsal tunnel syndrome, which involves nerves passing through the ankle into the foot

Belzberg says that for these entrapments non-surgical treatment usually comes first. But if exercise, splints and anti-inflammatory medicines don’t resolve the problem, he explains that surgery may be necessary to enlarge the “tunnels” of ligament and tendon surrounding a peripheral nerve.

“Nerve entrapment responds very well to surgery. The recovery is quick and people can get back to their regular activities.”

Complex Peripheral Nerve Injuries that May Need Surgery

Less common — and more complex — are peripheral nerve injuries due to nerve tumors or trauma. These often require surgery.

“In the U.S., we see peripheral nerve injuries caused by high speed motorcycle, car, snowmobile and all-terrain vehicle accidents, as well as falls,” Belzberg says. “The nerves can be stretched, cut or torn.”

One area likely to be hurt in a high-velocity crash is the brachial plexus—the branches of nerves that emerge from the spinal cord at the neck and pass through the shoulder into the arm and hand. Damage to the brachial plexus, if not treated successfully, can leave a patient with lasting, severe pain and disability.

Belzberg says, “Tumors, such as schwannomas and neurofibromas, can form along a nerve anywhere in the body. Fortunately, most of the time these tumors are benign and can simply be watched. They can also be associated with genetic disorders. Other times, they can grow and cause problems for the nerve or surrounding structures.”

Although Belzberg’s particular area of expertise is nerve tumors involving the spine, he works with a team of expert surgeons to remove these tumors from virtually any place in the body where they might occur.

A Multidisciplinary Approach to Peripheral Nerve Surgery

Whether addressing a compression, traumatic injury or nerve tumor, peripheral nerve surgery demands high skill and expertise — along with finely-tuned cooperation with other specialists.

Belzberg notes that the Johns Hopkins Peripheral Nerve Surgery Center offers patients a multidisciplinary approach, combining the expertise of orthopaedics, plastic and reconstructive surgery, physical medicine and rehabilitation, and neurology, as well as neurosurgery.

Experts in advanced imaging help Belzberg and his colleagues home in on the exact nature of the nerve injury to support effective surgery.

Belzberg also notes that ongoing research helps his group develop more advanced approaches to peripheral nerve repair. A considerable amount of his time and effort is directed at basic and translational science, where he collaborates and directs numerous ongoing projects.

“Through research, we’re learning more every day about how to help nerves regenerate and grow back. Our surgeons go back and forth between the operating room and our laboratories, bringing critical questions to the laboratory bench and taking cutting-edge knowledge and techniques back to the patient. That puts our expertise on the forefront, which benefits our patients.”

An Innovative Approach to Nerve Repair | Santi’s Story

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Santi's sciatic nerve was severed in a boating accident, paralyzing his right leg. He and his family traveled from Texas to Baltimore, where they met with neurosurgeon Allan Belzberg and orthopaedic trauma surgeon Greg Osgood. Together, the two surgeons collaborated to offer a novel way to repair Santi's leg and get him back to the water.