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Peripheral Nerve & Plexus Surgery Program

Introduction

The Peripheral Nerve and Plexus Surgery Program (PNPSP) at Cleveland Clinic's Neurological Institute is a specialized multidisciplinary clinic designed to diagnose and treat brachial and lumbosacral plexus disorders, and focal neuropathies of the upper and lower extremities, including peripheral nerve tumors, trauma, and entrapment. The program incorporates expert clinical evaluation, world class electrodiagnostic testing, state-of-the-art imaging technology, cutting-edge surgical management options, and post-operative rehabilitation and pain management services.

The Peripheral Nerve and Plexus Surgery Program offers the unique advantage of allowing select patients to undergo a prearranged same-day evaluation, including electrodiagnostic evaluation, imaging, and assessment by a neurologist and neurosurgeon with an expertise in treating these disorders. In some cases, evaluation over the two days is required. An interdisciplinary approach is utilized in order to provide a tailored treatment plan for each patient.

What We Treat

  • Brachial Plexus Disorders
  • Lumbosacral Plexus Disorders
  • Focal Peripheral Nerve Disorders:
  • Nerve Tumors
  • Nerve Injury/Trauma

    Assessment begins with a review of your prior medical evaluation, a complete history and physical examination by our staff, and the selective utilization of the following diagnostic techniques:

    Our multidisciplinary assessment incorporates input from neuromuscular and neurosurgical staff, yielding a comprehensive evaluation.

    Nerve & Plexus Surgery

    We use a combination of microsurgery and intraoperative mapping techniques (including somatosensory evoked potentials and nerve action potentials) to facilitate safe and effective surgical treatment.

    Pain and neurologic dysfunction can result from compression of the peripheral nervous system by arthritic joints and fibrotic tissue leading to a variety of syndromes including carpal tunnel syndrome and ulnar neuropathy. Microsurgical technique can be used to safely remove pressure from the peripheral nerve, thus relieving discomfort and allowing for nerve recovery after peripheral nerve injury. In some cases nerves may be mobilized and moved into alternative paths that further protect them from compression and repetitive trauma.

    In the case of peripheral nerve trauma, nerve action potentials and other diagnostic techniques are used to localize the regions of dysfunction within peripheral nerves. These areas of damage can then be repaired microsurgically either directly or with nerve grafts taken from other locations in the body.

    Finally, compression of the peripheral nervous system by tumors can also result in pain, weakness, and numbness. Tumors may arise within the peripheral nervous system or spread from other locations to the peripheral nervous system. As with trauma and compressive neuropathies, tumors may be safely dissected away from the peripheral nervous system sparing peripheral nerve function through the use of microsurgical technique in combination with intraoperative mapping.

    Specialized Rehabilitation for Peripheral Nerve/Plexus Disorders

    Rehabilitation is an integral component in the treatment of peripheral nerve and plexus disorders. Patients benefit from specialized protocols to maintain range muscle/tendon motion, nerve integrity/mobilization, and strength training. Issues related to function and activities often need to be addressed as well. Symptom management, particularly neuropathic pain management, is an important part of the program and will be addressed whether or not surgical repair is performed. An evaluation by a physiatrist (physician specializing in Physical Medicine and Rehabilitation) includes assessment of the patients' needs, and an opportunity to initiate and oversee the rehabilitation program. Referral to physical therapy and/or occupational therapy is warranted in most cases.

    Pain Management Approach

    In addition to medical and physical therapies, various surgical options may be selectively employed to manage nerve pain. Surgical pain management options are considered in patients with pain that (1) does not respond to medical therapies, and (2) is in an anatomic distribution which would be amenable to the therapies available. In order to tailor an effective approach, patients must undergo a comprehensive evaluation – including neuropsychological testing – to understand the physical, behavioral, cognitive, and emotional factors associated with their pain.

    A surgical option offered by the PNPSP involves placing an electrode over or around the affected nerve fibers, and delivering electrical stimulation to “override” the abnormal pain signals. This technique has been previously employed to assist patients with neuropathic facial pain, occipital neuralgia or cervicogenic occipital pain, post-herpetic neuralgia, post traumatic neuropathic pain, and post-surgical neuropathic pain. In selected patients, trial stimulation over 3 to 5 days resulting in 50% improvement in pain scores is required prior to surgical placement. The efficacy of implanted peripheral nerve stimulators in relieving chronic pain has been estimated at 31 to 63%, with an average post-operative improvement in pain scores of 50%.

    Peripheral Nerve & Plexus Surgery Program staff listing.

    Appointments can be scheduled by patients or their local physicians. In either case, all medical records pertaining to the prior peripheral nerve or plexus medical evaluation/treatment must be forwarded to the Clinic to facilitate appointment scheduling and coordination. Once your information is reviewed, we can tailor a visit to include clinical assessments, electrodiagnostic testing, and imaging based on your needs.

    Please call 216-636-5860 to initiate this process.

    If a patient is requesting consultation directly or a medical provider is referring a patient, please complete and sign a HIPAA Compliant Medical Release, and give it to your local provider(s) with a request to forward all prior records, including clinic notes, surgery notes, relevant laboratory test results, imaging reports (MRI, CT, ultrasound), prior nerve conduction study and electromyography reports to:

    Peripheral Nerve and Plexus Surgery Program
    c/o Steven Shook, MD
    9500 Euclid Ave, S90
    Cleveland, OH 44195