As a neurosurgeon, Dr. Foroohar treats conditions affecting the peripheral nervesin the arms and hands, and legs and feet. Peripheral nerve conditions are very common. They can be related to repetitive use, work injuries or age.
The most common peripheral nerve conditions seen are carpal tunnel syndrome and ulnar neuropathy. Dr. Foroohar treats these conditions with surgery to release the nerve.
Carpal tunnel syndrome is a condition that produces numbness, tingling, burning or aching pain in the fingers and hand. This condition results when the median nerve is compressed or damaged at the wrist.
Ulnar neuropathy is a neurological condition caused by entrapment or pinching of the ulnar nerve at the elbow or wrist. The result is numbness and tingling in the fourth and fifth fingers and arm.
Dr. Foroohar Answers Questions About Peripheral Nerve Conditions
How do you perform surgery for carpal tunnel syndrome?
The carpal tunnel is right above the wrist on the palm side of the hand. We make a small incision and cut that ligament to free the nerve.
How is ulnar neuropathy treated surgically?
The ulnar nerve runs through the elbow. In patients with ulnar neuropathy, usually the nerve is slightly tethered or attached. We try to free it up, and sometimes mobilize it to the other side of the bone so there's no pull on it.
Are peripheral nerve injuries always caused by repetitive stress?
Not always. These could be repetitive-stress injuries, but sometimes they're not. Patients don't have to have a specific history of doing something to get carpal tunnel syndrome or ulnar neuropathy.
You don't have to say, “Because I do this, I get it.” Anybody can get a peripheral nerve injury.
How do you diagnose carpal tunnel syndrome?
We can diagnose carpal tunnel based on your symptoms and the examination, but I always want an EMG. Without an EMG, I would never do surgery. We want neurophysiological evidence that the nerve is pinched and damaged.
How long is the recovery from peripheral nerve surgery?
It's not that the surgery is a big deal, but you use your hands a lot, so that limits you in going back to work. I usually keep patients off work for a month. It all depends on the kind of work you do.
Why choose a neurosurgeon for peripheral nerve conditions?
Carpal tunnel syndrome is treated by so many specialists—orthopedic surgeons, hand surgeons, plastic surgeons, general surgeons. Neurosurgeons operate on the brain and spinal cord, the nerve roots.
I do think that as neurosurgeons, we truly understand nerves the best. When it comes to freeing the nerve, the neurosurgeon's approach is going to be much more thorough in making sure the nerve is free.
Having rapid onset, severe symptoms and a short course—not chronic.
Cadaver bone graft.
Bone graft taken from another site on the patient's body.
A term describing cancer cells that divide rapidly and bear little or no resemblance to normal cells.
(pronounced AN your ism) A defect or a weakness in the wall of a blood vessel that causes an out-pouching. A cerebral aneurysm is an aneurysm of a blood vessel in the brain. If untreated, aneurysms may rupture (burst), causing a subarachnoid hemorrhage. Cerebral aneurysms may be from a congenital predisposition (genetic tendency), atherosclerosis (hardening of the arteries), and less likely from infectious or traumatic sources.
A type of plastic that softens in hot water and solidifies when cooled. Aquaplast masks are used to hold the head still for CyberKnife treatments.
Bio comes from the ancient Greek word bios, meaning life. Mechanics is an engineering concept that relates to structure and function. In the instance of back surgery, biomechanics refers to the structure and function of the spine.
A procedure in which tumor tissue is removed from the body for examination under the microscope by a pathologist. A biopsy is performed to determine whether or not cancer is present. It can be done in an open or stereotactic manner through a needle biopsy.
Pieces of bone taken from the patient's body (autograft) or a cadaver (allograft) and placed on the facets or inner space of the spine. These grafts eventually grow together, forming a spinal fusion.
The lower extension of the brain that connects to the spinal cord and conducts information between the brain and spinal cord.
Carpal tunnel syndrome
A condition producing numbness, tingling, burning, or aching pain in the fingers and hand when the median nerve is compressed or damaged at the wrist.
Cauda equina syndrome
Sufficient pressure on the low-back nerves to produce multiple nerve root irritation with leg and foot weakness. Cauda equine syndrome often causes loss of bowel and bladder control.
Long-term; the opposite of acute.
Pertaining to the neck and upper back.
The use of drugs, given orally or by injection, to treat cancer.
Fracture of the spinal vertebral body. If the entire vertebra is crushed, it is called a burst fracture. Compression fractures can be caused by osteoporosis (a condition resulting in weak, brittle bones), or by traumatic injury. Some older adults have multiple compression fractures.
Normal tissues near a tumor. For example, the optic nerve and brainstem are considered critical structures when treating brain tumors. The spinal cord is the primary critical structure to consider when treating spinal tumors.
Computed tomography—combined x-ray images that with aid of a computer generate cross-sectional views of the brain or other parts of the body.
A round cartilage cushion between the bones (vertebrae) of the spinal column.
Surgery to remove a disc.
Critical areas of the brain that control movement, sensation, speech, comprehension and vision.
A test to evaluate nerve and muscle function.
Involving glands, such as the thyroid and the adrenals, that secrete hormones.
The joints located in the back of the spine. The facets connect one level to the next and allow for range of motion between levels.
Markers placed into a tumor to better identify and track it on an x-ray.
An inability or difficulty in moving the ankle and toes upward.
A broken bone.
A specialized MRI that measures changes in blood flow related to neural activity in the brain or spinal cord.
The process of fusing or uniting bone, such as in the spine.
A malignant tumor derived from glial cells in the brain. It is a Grade IV astrocytoma. Astrocytomas are the most common type of brain cell tumors. Grade IV tumors are the most malignant type.
A tumor that arises from the brain's supportive tissue. Gliomas are the most common primary brain tumors.
A unit of measure for radiation doses.
Accumulation of blood, regardless of the root cause, in the body tissues—a hemorrhage. Hematomas are usually caused by a break in a blood vessel resulting in bleeding.
Same as hematoma. Accumulation of blood or bleeding in the body tissues.
Involving or overlapping of two or more health care professions in a cooperative manner or effort.
Part of the vertebra in the back of the spine. For each vertebra, two laminae connect the pedicles (the roots of the vertebral arch) to the spinous processes (the small bone extensions you can feel when you touch your back), forming the roof of the spinal canal.
Surgery to remove part of the spine known as the lamina—the bone in the back of the spine. Laminectomies are performed to relieve pressure on the spinal cord or spinal nerves.
Fibrous tissue that connects bones to other bones.
Pertaining to the lower back.
A nerve running down the arm to the hand.
A type of tumor that grows from the protective membranes or meninges surrounding the brain and spinal cord. Most meningiomas are benign or non-cancerous.
(also called evoked responses) Electrophysiological responses recorded from muscles after direct electromagnetic stimulation of the brain.
Magnetic resonance angiography—a type of MRI scan that provides pictures of blood vessels inside the brain and body. It can help detect cerebral aneurysms.
Magnetic resonance imaging. A diagnostic imaging technique that uses a magnetic field and radio waves to produce highly detailed images of the brain, spine and body. This painless procedure uses no radiation.
Compression of the spinal cord by a herniated disc or stenosis, causing weakness and difficulty walking.
Abnormalities such as weakness or paralysis of the face, arm or leg, numbness, visual loss, speech loss, hearing loss or swallowing difficulty.
A physician who specializes in treating the nervous system and the disorders affecting it, but does not do surgery.
A physician who specializes in nervous system function.
A physician who specializes in caring for cancer patients.
A medical doctor who specializes in surgery of the bones, joints, ligaments, tendons, muscles and related structures.
The medical specialty focusing on diseases of the ears, nose and throat, as well as head and neck disorders.
The branch of medical science that uses an interdisciplinary approach, including injections and medications, to relieve pain and improve the quality of life for patients with chronic (long-term) pain.
The small bone that connects the bones in the back of the spine to the vertebral body.
(pronounced fizz EYE uh trist) A physician specializing in physical medicine and rehabilitation.
(pronounced fizz EYE uh tree) A medical specialty focused on physical medicine and rehabilitation
A treatment method that uses physical methods, such as stretching and strengthening exercises, massage, or the application of modalities to treat injuries or disorders.
The expected outcome of a disease, based on medical knowledge.
The treatment of disease (especially cancer) by exposure to a radioactive substance.
A physician who treats cancer with radiation therapy.
A scientist who helps plan complex radiation treatments. He or she makes sure the calculations are performed correctly and that the machine delivers the proper amount of radiation to the correct site in the body.
A technician who assists the radiation oncologist and usually delivers the radiation treatments.
(pronounced ruh DIC you LOP a thee) Pain, weakness or numbness radiating down the arms or legs resulting from an irritated nerve root in the spine, as from a herniated disc or stenosis.
Non-invasive treatment of benign and malignant tumors with precisely targeted beams of radiation therapy. Also known as stereotactic radiotherapy.
Surgical removal of tissue such as a hematoma or tumor.
An abnormal sideways curvature of the spine.
Painful, involuntary muscle contractions.
Surgery to join and fuse two or more vertebrae with bone graft, hardware including screws and plates, or cages to stabilize the spine and relieve pain.
A slipping forward of a spinal vertebra over the one below it.
A ligament injury caused by being stretched beyond normal capacity, and partially or completely torn.
Abnormal narrowing of the spinal canal in the neck or back that can lead to pinching of the spinal cord and/or nerves in the spine.
A partial tear of a muscle.
Pertaining to the mid-back (behind the rib cage).
Caused by a physical injury or wound due to external force or violence.
A nerve running along the inner side of the arm and passing near the elbow.
A condition caused by entrapment of the ulnar nerve at the elbow or wrist, resulting in numbness and tingling in the fourth and fifth fingers.
(singular: vertebra): The bones that make up the spine.
The front bony area of the spine that makes up the largest part of a vertebra.