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Peripheral nerves (meaning those nerves outside of the spinal cord which provide movement and feeling in many different parts of the body) travel throughout our bodies and, in certain areas, are vulnerable to compression. If a nerve in one of those vulnerable regions becomes injured or inflamed, it may begin to swell and become compressed. This pinching of the nerve will decrease blood flow in the nerve over time. The nerve will become sticky and no longer glide through certain narrow anatomical areas, known as “pinch points,” and as a result, the nerve will begin to undergo changes internally. At first, the myelin wrapped around the nerve fibers for insulation will lessen, creating symptoms of altered sensations such as burning, tingling, or aching pain in the region and weakness in the affected muscles. As the compression worsens, these symptoms often progress to numbness in the region and the muscles begin to atrophy. If these symptoms are recognized and treated, the nerve can heal, the tingling and abnormal feelings can improve, and weakness can get better. Even in advanced cases where there is numbness and muscle atrophy, the sensation and the muscle strength can often improve with treatment.
Once nerve compression is recognized, it can often be treated with non-invasive means, such as splinting or steroid injections. In certain circumstances, surgery may be recommended. Many nerve compression syndromes, such as carpal tunnel (at the wrist) and cubital tunnel (at the elbow), particularly when they are caught early, can respond well to temporary immobilization of the joints to avoid undue pressure on the affected nerves. In more mild cases, this treatment may begin immediately after a patient’s evaluation. Steroid injection, in the case of carpal tunnel syndrome, is also an effective option in less severe cases. When these treatments are not effective, surgery to relieve the nerve compression is recommended. During surgery, the structures that are compressing the nerve are surgically released to allow for better blood flow within the nerve. This surgical release of the nerve aids in healing the nerve and in preventing further injury.
In rare cases, nerve compression can reoccur after surgical treatment due to excessive scar formation or due to the nerve scarring to the overlying skin. In these cases, nerves must again be surgically released from scar in a procedure termed a neurolysis. In such cases, either local tissue or biocompatible materials are used to wrap the nerve to protect it from further tethering in scar tissue.
Although it may take weeks or months for the sensation and the muscle strength to recover after nerve release, typically patients notice decreased symptoms of pain, burning and tingling immediately following surgery. There is soreness expected at the operative site which will gradually improve over several weeks. If there is numbness and muscle atrophy prior to surgery, these symptoms improve over a longer period of time because of the severity of the nerve damage from compression.
Division of Plastic and Reconstructive Surgery
Wang Ambulatory Care Center 435
We are also located at:
Mass General/North Shore Center for Outpatient Care 102 Endicott Street Danvers, MA 01923
The Mass General Division of Plastic and Reconstructive Surgery is located in the Wang Ambulatory Care Center at 15 Parkman St. Parking is available in the Parkman St. and nearby Fruit St. and Yawkey Center garages. Please note that some GPS systems do not recognize the 15 Parkman St. address. If you use a GPS system to drive to Mass General, enter Blossom St. as your destination, and then turn onto Parkman directly from Blossom.
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