Ann Song, MD, neurologist at MedStar Franklin Square in Baltimore, offers a comprehensive approach to provide care to patients who suffer from nervous system disorders.
Peripheral nerves—the part of the nervous system that is not your brain or spinal cord, but the nerves that radiate out toward your body—can be damaged by many types of injury or trauma, as well as from conditions such as
- Motor neuron diseases, like Lou Gehrig's disease
- Nutritional deficiencies, including lack of B6 and B12 vitamins
- Medication side effects
General symptoms of damaged peripheral nerves include
- Twitching, tingling, or burning
- Inability to sense pain
Your MedStar Health specialist will conduct a thorough examination, including a neurological exam to assess nerve function and determine the origin of the damage. Depending on the cause, a treatment plan may include one or more of the following:
- Medications, to control the symptoms
- Physical or occupational therapy
- Surgery, to release the compression around the nerves.
Please note: The skilled neurologists at MedStar Franklin Square Medical Center can treat most neurological conditions on site. Patients who need physical therapy or surgical procedures will be referred to other specialists, as appropriate.
The following are peripheral nerve conditions treated by MedStar Health specialists.
- Carpal Tunnel Syndrome
- Chronic Migraines Headaches and Occipital Neuralgia
- Chronic Pain Following Surgery or Trauma
- Cubital Tunnel Syndrome
- Diabetic Neuropathy
- Meralgia Paresthetica
- Peripheral Nerve Tumors
- Peroneal Nerve Neuropathy
- Tarsal Tunnel Syndrome
Carpal Tunnel Syndrome
The carpal tunnel is a space in the wrist where a nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome is a type of hand nerve entrapment that occurs when swelling in the tunnel compresses the median nerve. As a result of the pressure on the median nerve, patients with carpal tunnel syndrome may experience pain and weakness in the hand, wrist, or fingers. Often, this must be treated surgically before the nerve is irreversibly damaged.
Chronic Migraines Headaches and Occipital Neuralgia
A migraine is a common type of headache that can occur with symptoms such as nausea, vomiting or sensitivity to light. In many people, the throbbing pain is felt on only one side of the head. A migraine is different from a tension headache, although some people suffer from a mixed tension migraine, which has features of both a migraine and a tension headache. For patients with chronic migraines who do not find relief with medications or lifestyle changes, peripheral nerve surgery may be the answer. More information on headaches is available here.
Chronic Pain Following Surgery or Trauma
Patients who suffered a trauma or had to undergo a surgery may experience chronic pain and/loss of sensation afterward. Chronic pain is defined as pain persistent beyond the normal recovery time for a given trauma or surgery.
Examples of chronic pain following surgery or trauma include:
- Groin pain after hernia repair surgery or following a c-section or hysterectomy
- Knee pain following knee replacement or arthroscopy
- Breast pain after breast reconstruction or other breast surgery
- Upper or lower extremity pain following orthopaedic surgery
- Amputation stump pain, also called phantom limb pain
Often, the cause of chronic pain is nerve damage, because the nerve itself was damaged directly, or the nerve is caught in the scar tissue as the body heals itself. Medication is often prescribed to treat the symptoms, however as tolerance to the medicine grows, it becomes less and less effective. And surgery becomes an option.
Phantom Limb Pain
The main symptom of phantom limb pain is the feeling of pain in the missing part of your limb. Different patients describe the pain in different ways. Some say it feels like a sharp or shooting pain. Others describe it as achy, burning or cramping. Over time, phantom limb pain should lessen.
- You should be evaluated for phantom limb pain if your pain persists:
- Beyond the expected recovery period after your surgery, usually three to six months
- Despite optimal care prescribed to you by your primary care physician or your surgeon
- Despite symptomatic supportive care, such as medical pain management and physical therapy
- When using your prosthesis
At MedStar Health, our surgeons are experts in diagnosing and treating phantom limb pain. Our peripheral nerve surgeons receive additional training focusing specifically on nerves, to ensure that you receive the best possible care from top experts in the field.
Cubital Tunnel Syndrome
The cubital tunnel is a narrow tube of tissue at your elbow that contains the ulnar nerve. The ulnar nerve runs from your shoulder down to your wrist and controls movement in your ring and pinky fingers. Cubital tunnel syndrome is a type of hand nerve entrapment that forms when this tunnel swells, putting pressure on the ulnar nerve, causing pain and numbness in the hand and fingers. Your doctor may recommend a course of physical therapy, medication and rest. However, if you are still experiencing symptoms despite this course of treatment, one of our peripheral nerve surgeons should evaluate you to see if you are a candidate for surgery.
Diabetic neuropathy is a common complication of diabetes, wherein high blood sugar levels (hyperglycemia) damage the nerves.
The goals of treating diabetic neuropathy are to prevent the disease from getting worse and to reduce the symptoms of the disease. First, it is crucial to be in control of your blood sugar level to keep problems from getting worse. Medications may be used to reduce symptoms in the feet, legs, and arms.
Sometimes, diabetic patients may be candidates for peripheral nerve surgery. If the symptoms continue along known compression nerve sites and worsen despite medication or other treatments, nerve surgery can help if done early and can prevent permanent nerve damage.
Meralgia paresthetica, the pinching of the nerve that travels from the spine to the thigh, causes feelings of burning, pain, and numbness along the outer and front part of the thigh. It can result from trauma to the area, diabetes, tight clothing, obesity, and pregnancy.
Peripheral Nerve Tumors
A peripheral nerve tumor grows along the path of a nerve. Often, these tumors are slow-growing and benign, and cause varying degrees of pain, numbness, or muscle weakness. Surgery is generally necessary to remove the peripheral nerve tumor. Depending on the type of tumor, the exact type of surgical treatment may vary. Following the tumor removal, you will probably need physical or occupational therapy to keep the affected muscles and joints active and prevent stiffness. You may need a brace or a splint to help hold the affected limb in the proper position.
Peroneal Nerve Neuropathy
Peroneal nerve neuropathy occurs when a branch of the sciatic nerve is damaged. This nerve provides movement and sensation to the lower leg, foot, and toes, and, when damaged, can lead to
- Decreased sensation in the top of the foot, or the outer part of the upper and lower leg
- Numbness or tingling in that same area
- Weakness in the ankles or feet
- Walking abnormalities
- A slapping gait, a walking pattern in which each step makes a slapping noise
- Foot drop, meaning you cannot hold your foot in a horizontal position
- Toes dragging while walking
Tarsal Tunnel Syndrome
The tarsal tunnel is a space where the leg (tibial) nerve travels down to the ankle. This condition occurs when the tunnel swells, compressing the tibial nerve and causing pain, burning, and tingling occur along the inside of the ankle, heel, arch, and sole of the foot. Symptoms tend to increase as the day progresses and are usually worsened with increased activity, such as walking or exercise. Tarsal tunnel syndrome is a complex condition that often requires to nerve decompression surgery.