Peripheral nerve surgery

Peripheral nerve lesions often result from traumas (closed and open wounds) or through compression due to anatomical pressure points. The treatment of these lesions depends on their severity, the degree of injury to the adjacent structures and the time factor (the treatment should optimally be carried out within a half year).

Depending on the segmental nerve defect, nerve sutures or nerve transplants are used in surgery. If no upper nerve stump is available, we resort to nerve fibre transfer. In special cases, all the techniques are combined with each other. The combination goes so far that we combine nerve operations with reconstructive procedures such as muscle-tendon transfer in one operative session.

Operative interventions in these areas lead as a rule to good results, insofar as these are carried out in time. The regeneration of the nerve fibres has a maximum speed of 1 mm per day, i.e. nerves regenerate slowly.

The brachial plexus, the so-called arm neuroplexus, is formed from nerves of the spinal marrow from which peripheral nerves form. In cases of brachial plexus injury, varying degrees of severity of immobility, sensibility disturbances and/or pain in the arm and shoulder area can occur.

The treatment is initially conservative, e.g. with physical and electro therapy, insofar as no avulsion or tear from the spinal marrow has been diagnosed. If no regeneration occurs within three to six months, a surgical intervention is necessary. The chances of recovery are dependent on the severity of the injury, the time that has already passed since the injury and the age of the patient Injuries to the nerves of the upper extremities The nerves of the upper extremities are formed from the arm neuroplexus (brachial plexus). The key nerve trunks are the Nervus suprascapularis, Nervus axillaris, Nervus musculocutaneus, Nervus radialis, Nervus medianus and Nervus ulnaris.

The nerves of the upper extremities are formed from the arm neuroplexus (brachial plexus). The key nerve trunks are the Nervus suprascapularis, Nervus axillaris, Nervus musculocutaneus, Nervus radialis, Nervus medianus and Nervus ulnaris. 

The lumbosacral plexus is formed from the spinal marrow roots of the lower spinal marrow. All the peripheral nerves of the lower extremities are formed from the lumbosacral plexus. Injuries to the lumbosacral plexus can cause varying degrees of severity of immobility, sensibility disorders and/or pain in the legs.

Injuries to the lumbosacral plexus are initially treated conservatively: if there is no tearing or avulsion from the bone marrow, then with physical and electro therapy. If there is no regeneration within three to six months, an operation is necessary. The chances of healing are extremely dependent on the severity of the injury.

The lumbosacral plexus is formed from the spinal marrow roots of the lower spinal marrow. All the peripheral nerves of the lower extremities are formed from this. Injuries to the lumbosacral plexus can lead to varying degrees of severity of immobility, sensibility disorders and/or pain in the legs.
The treatment is initially conservative, e.g. with physical and electro therapy, insofar as no tearing or avulsion from the spinal marrow has been diagnosed. If no regeneration occurs within three to six months, a surgical intervention is necessary. The chances of healing are dependent on the severity of the injury, the time that has already elapsed since the injury and the age of the patient.

The lower extremities comprise the pelvis, thighs, knees, lower legs and feet. The operative treatment spectrum ranges from the microsurgical reconstruction of the damaged peripheral nerves to complex tumour removals, the reversal of surgical injury consequences and the reconstruction of lost functions.

Some patients who suffer from a peripheral nerve injury can develop complications that necessitate a further operation. These can include scarring that hinders or compromises regeneration and can lead to the full cicatricial alteration of a nerve segment. We carry out the following treatments:

• Microsurgical neurolysis and decompression of a peripheral nerve
• Restoration of the sliding behaviour of peripheral nerves by means of special tissue transplant flaps
• Nerve transplants to restore nerve continuity
• Nerve fibre transfer
• Restoration of function through multiple tendon and muscle transfer
• Restoration of muscle balance
• Arthrolysis (release of joint stiffness)
• Tenolysis (release of tendon stiffness)
• Joint support for the improvement of global function
• Reconstructive surgery, skin transplants and tissue transfer

Irritations of the peripheral nerves (caused spontaneously or after an operation or injury) are often the cause of neuropathic pain that can develop into the so-called chronic pain syndrome.

The usual symptoms of a nerve irritation are sensitivity disturbances such as burning, electrifying pain, paraesthesia and pain upon stimuli that are normally not perceived as unpleasant. In some cases, the irritation can lead to a feeling or heaviness or numbness. These symptoms are restricted to the supply area of the affected nerve.

If the complaints go beyond this area and additional symptoms occur, such as swelling, an altered skin temperature and colour, as well as very severe pain, it could be a case of a Chronic Regional Pain Syndrome (CRPS).
The operative treatment of a nerve irritation depends on whether there is a surgically remediable nerve situation.

To establish this, we carry out a thorough clinical examination, a high-resolution nerve ultrasound examination, if necessary a neuro MRI (magnetic resonance imaging) and repeated local blocks of the nerves. In almost all cases, we recommend medicinal treatment alongside the operation.
If no operation is possible, treatment is purely medicinal or with nerve stimulators or spinal marrow stimulators

In the case of compression syndromes of peripheral nerves, there is an entrapment of a peripheral nerve (trapped nerve) at an anatomical constriction, e.g. at the carpal canal (carpal tunnel syndrome CTS) or the cubital tunnel (cubital tunnel syndrome).

This can cause various losses of function and/or pain regarding the affected nerve. Compression syndromes of peripheral nerves can occur on any section of the peripheral nerve system but most frequently on the arms and legs. We treat:

• Median nerve compression syndromes such as carpal tunnel syndrome (CTS) or Pronator teres syndrome
• Ulnar nerve compression syndromes, such as the Loge de Guyon syndrome or Sulcus nervi ulnaris syndrome (cubital tunnel syndrome)
• Radial nerve compression syndromes, such as supinator syndrome
• Suprascapular nerve entrapment syndrome
• Thoracic outlet syndrome (TOS)
• Tarsal tunnel syndrome (TTS)
• Meralgia paraesthetica
• Other

If after a trauma there is a critical inadequate blood supply to the whole arm or the lower arm and the hand for more than six hours, the muscles die off and scar over. This scarring causes a contracture of the muscles with malpositions of the joints.

This is a so-called Volkmann’s contracture. The treatment comprises the easing of the contracture incl. tenolysis, arthrolysis and muscle-tendon transfers incl. free muscle-tendon transfers
 

Spastic paralysis is a spasmodic immobility that is caused by damage to the central nervous system. The symptoms comprise muscle cramps, joint stiffness and mobility disorders. Spastic paralysis can occur on one or both sides of the body and as a rule is permanent.

The treatment of spastic paralysis focusses on easing the symptoms and improving function. Conservative measures such as physical therapies and Botox injections are the most common treatments.
Muscle-tendon transfers, tendon lengthening and so-called hyperselective neurotomies (nerve severing) can significantly improve the symptoms.

Peripheral nerve tumours (PNT) are a rare group of tumours that emerge from the cells of the peripheral nerve system (PNS). Most of these tumours are benign but some can be malignant. The treatment of PNT depends on the type of tumour and its location.
In many cases, the tumour can be completely removed by means of an operation. If the tumour is malignant or cannot be fully removed, radiotherapy or chemotherapy may also be necessary in some circumstances. In such cases, we cooperate on an interdisciplinary basis with highly specialised colleagues at the Wiener Privatklinik hospital.

One of the most common nerve tumours is the so-called schwannoma. This is a slowly growing tumour of the Schwann cells that almost always originates from a sensitive part of the nerve. We only remove this tumorous segment and preserve the non-affected parts of the nerve. This conserves the function of the nerve.

Some disorders, such as congenital muscle or nerve disorders, lead to joint stiffening and malpositions that lead to a significant restriction of function. Through the establishment of a new muscle-tendon balance after releasing the contracture, we can improve the function of the affected extremity at our hospital.