Surgery of Louisville

Conditions we treat

Nerve Conditions 

Carpal tunnel syndrome is a condition that causes numbness, tingling and other symptoms in the hand and arm. Carpal tunnel syndrome is caused by a compressed median nerve in the carpal tunnel, a narrow passageway on the palm side of your wrist.  The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).

Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.  The anatomy of your wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome.  Proper treatment usually relieves the tingling and numbness and restores wrist and hand function.

Cubital Tunnel Syndrome is a condition that involves pressure or stretching of the ulnar nerve (also known as the “funny bone” nerve), which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand.  The ulnar nerve runs in a groove on the inner side of the elbow.  Cubital tunnel syndrome can cause pain, loss of sensation, tingling and/or weakness. “Pins and needles” usually are felt in the ring and small fingers. These symptoms are often felt when the elbow is bent for a long period of time, such as while holding a phone or while sleeping. Some people feel weak or clumsy.

Sometimes, nerve testing (EMG/NCS) may be needed to see how much the nerve and muscle are being affected. This test also checks for other problems such as a pinched nerve in the neck, which can cause similar symptoms. Sometimes, surgery may be needed to relieve the pressure on the nerve. This can involve releasing the nerve, moving the nerve to the front of the elbow, and/or removing a part of the bone. 

Patients having undergone upper or lower extremity amputation for traumatic injuries or tumor removal often report pain due to neuroma formation at the site of limb removal. Post-amputation stump pain due to neuroma formation has been shown to be a barrier to successful prosthesis utilization.

For patients having significant pain and disability at their site of amputation, Dr. Nicoson is able improve patient's quality of life and reduce neuroma pain with surgical techniques including neuroma excision, neurolysis, nerve transposition, nerve implantation into muscle / bone, and in some cases nerve transfer.

If you have had a limb amputation and are having pain and disability, surgical treatment options exist that can reduce neuroma pain, decrease analgesic usage, and allow improved quality of life.

Limb Amputation Stump Pain

Nerves are critical to the body's function, providing sensory input and motor control of the extremities. When damaged from a traumatic laceration, tumor removal or surgery, these critical nerve functions are lost. This results in patients having pain, numbness and inability to perform certain movements directly related to nerve damage.  Early recognition of the nerve injury and referral to a peripheral nerve specialist like Dr. Nicoson, allows for timely surgical intervention to repair the damaged peripheral nerve to restore lost function and minimize future deficits. Nerve recovery is slow even with appropriate treatment and sometimes needs to be augmented with nerve transfer or tendon transfer procedures to optimize outcomes.

If you have sustained a traumatic laceration or have had a recent surgery where there is concern for a peripheral nerve injury, seek medical evaluation as soon as possible. Often earlier surgical intervention is critical to overall patient improvement.  Examples of peripheral nerve injury:

  • Finger or hand lacerations resulting in numbness and pain beyond the site of injury
  • Shoulder or elbow dislocations with loss of sensation or extremity function
  • Soft tissue or nerve tumor removal surgery with post-operative pain, tingling or loss of function

Radial tunnel syndrome is a set of symptoms that include fatigue or a dull, aching pain at the top of the forearm with use. Although less common, symptoms can also occur at the back of the hand or wrist.

The symptoms are caused by pressure on the radial nerve, usually at the elbow. The radial nerve is one of the three main nerves in the arm. It runs from the neck to the back of the upper arm. Next, it crosses the outside of the elbow and goes down to the forearm and hand. At the elbow, the radial nerve enters a narrow tunnel formed by muscles, tendon, and bone. This is called the radial tunnel.

Peripheral nerve surgeries are often performed by surgeons with little training in peripheral nerve disorders. Patients often present to our clinic complaining of their continued experience of pain, tingling and numbness despite prior surgery to repair or decompress their damaged nerves.

Revisional peripheral nerve surgery can be a very powerful tool to diminish these negative symptoms and allow patients to recover to a more functional level. Often re-exploration reveals the peripheral nerves to be incompletely decompressed, as in the case of persistent tingling and numbness in patients having had a prior carpal tunnel decompression. Patients with prior nerve repairs who are still experiencing issues are often found to have a neuroma, or tangled nerve regrowth, preventing further clinical improvement. These conditions are amenable to surgical treatment and will not improve with continued observation.

If you have had a prior nerve decompression, such as a carpal or cubital tunnel release and have not had any clinical improvement, schedule an appointment for an evaluation.  Recent cases of revisional nerve surgeries:

  • Persistent tingling and numbness in the ring and small finger of a patient who had a prior ulnar nerve decompression. The patient was told to keep waiting for improvement despite no clinical signs of change.  A revisional procedure was performed that showed the ulnar nerve to be encased in a dense scar. The ulnar nerve was freed from its scarring and also transposed into a new location to prevent future nerve compression.
  • Dense numbness and tingling in a patient with two prior carpal tunnel decompressions. A revisional procedure was performed demonstrating a scarred median nerve that had been partially lacerated by the initial treating surgeon. The median nerve was dissected out of the scarred tissue and placed in a healthy tissue bed with a vascularized fat flap to help cover it.