Nerve Conditions and treatment

Carpal Tunnel Syndrome

It is a condition which affects the hand and arm. Affected people experience pain, numbness and tingling sensation in the hands and arms. It is caused by compression of the median nerve at the wrist. It can affect one or both arms in varying degree of severity. Symptoms usually start gradually, with frequent burning, tingling, or numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. The symptoms often first appear in one or both hands during the night. A person with carpal tunnel syndrome may wake up feeling intense pain or numbness. Diagnosis is made based on a patient’s description of symptoms, history, clinical examination and nerve conduction study.

Non-surgical treatment includes avoiding postures of wrist that triggers symptoms, anti-inflammatory drugs, splints and exercises.

Open Surgery

An incision is made in the palm of the hand over the carpal tunnel and the ligament is cut thereby freeing the nerve.

Endoscopic Surgery

A small incision is made at the wrist. An endoscope is introduced inside the carpal tunnel and the ligament is cut. This procedure can be done safely and it has certain advantages over open surgery like smaller incision hence smaller scar, less pain and early return to work.

Meralgia Paresthetica

Meralgia paresthetica is a condition characterized by tingling, numbness and burning pain in the outer thigh. The cause of meralgia paresthetica is compression of the nerve (The lateral femoral cutaneous nerve – LFCN) that supplies sensation to the skin surface of the thigh.

Compression of the LFCN may be caused by something as simple as tight clothing or belt, or by injury, surgery, diabetes, pregnancy, and in rare instances, infections. Often a specific cause cannot be determined.

In most cases, a diagnosis of meralgia paresthetica is made based on the medical history and a physical examination. Nerve conduction study, electromyography etc may be required in some cases to rule out other conditions.

Removing the cause of compression is the best therapy. This can be achieved by wearing loose clothing, loosing weight and exercises. Common pain killers and certain medications may be required to relieve pain. When pain is severe or persistent, local nerve block may be required. In rare circumstances, surgical exploration and decompression of the nerve is indicated.

Peripheral Nerve Blocks

It is a technique where a combination of a local anesthetic and steroid are injected near a specific nerve or a nerve bundle to relieve pain. It is commonly used for the treatment of severe neck or back pain, pain in the face or limbs. The procedure is often done under imaging guidance like ultrasound guidance, X-ray or CT scan, to improve the accuracy and efficiency of the treatment.

Duration of pain relief varies according to the cause of pain and the drugs used. The procedure may be repeated several times, depending on the clinical condition. It is usually done as a day care procedure.

Tumors of Nerves

Tumors can arise from a nerve anywhere in the body. A large majority of peripheral nerve tumors are benign (not cancerous). Generally slow growing, these tumors can form within the substance of the nerve itself, and cause the nerve to gradually expand. Untreated nerve tumors begin to compress the adjacent nerve fibers, causing nerve dysfunction. Patients may experience pain, numbness, and/or weakness in the distribution of the affected peripheral nerve. The common tumors are neurofibroma, schwannoma, malignant peripheral nerve sheath tumor etc.

Medical history, examination and investigations like CT scan or MRI are required to arrive at a diagnosis. In most of the cases, surgical excision to obtain a diagnosis and to cure the tumor is indicated.