Peripheral Nerve Center | Neurology & Neurosurgery | Loyola Medicine

Peripheral Nerve Center

Leading-Edge Care to Diagnose and Treat Peripheral Nerve Injuries and Disorders

Loyola Medicine’s Peripheral Nerve Reconstructive Surgery Program takes a comprehensive, multidisciplinary approach to peripheral nerve injuries and disorders, such as compressive neuropathies, nerve injuries and nerve tumors.

Peripheral nerves send signals to and from the brain, as well as messages to and from the spine and the rest of the body. When these nerves become compressed or damaged, it can result in numbness, severe chronic pain or paralysis in different parts of the body. Peripheral nerve disorders (peripheral neuropathy) can be inherited or develop as a result of other conditions, such as diabetic neuropathy, inflammation, immune response or trauma.

Loyola’s highly experienced specialists will determine what is causing your symptoms and deliver the highest quality of care. You will work with a multidisciplinary team—which may include anesthesiologists, neurologists, neurosurgeons, orthopaedic surgeons, plastic surgeons, physiatrists and rehabilitation specialists—who will guide you through diagnosis, treatment and beyond.

Why Choose Loyola for the Treatment of Peripheral Nerve Injuries and Disorders?

Loyola’s compassionate team understands that peripheral nerve disorders can be life-changing not only for the patient, but also for family members. Loyola takes a multidisciplinary approach to patient care and provides support services for patients and families.

Loyola's neurosurgery and orthopaedic surgery departments are nationally recognized for providing exceptional care in an academic setting. Loyola provides compassionate, exceptional care to patients and trains future leaders in neurosurgery and orthopaedic surgery.

What are Peripheral Nerve Injuries and Disorders?

Peripheral nerve disorders can develop as a result of inflammation or an immune response. With compressive peripheral neuropathy, nerve entrapment can lead to nerve damage, as with carpal tunnel syndrome (CTS). Nerves can also become damaged due to trauma, such as a motorcycle accident.

Peripheral nerve disorders treated by Loyola’s highly skilled neurosurgeons and orthopaedic surgeons include:

Nerve compression/entrapment syndromes — Also known as compressive peripheral neuropathy, compression in the peripheral nerves causes a numbing sensation. Pain and progressive weakness may also occur. Carpal tunnel syndrome is the most common of these syndromes and involves the median nerve in the hand. Ulnar nerve entrapment at the elbow is also a common condition which causes tingling and reduced hand dexterity and strength. Loyola’s expert surgeons also care for patients with thoracic outlet syndrome, common peroneal nerve entrapment and tarsal tunnel syndrome.

Nerve injuries — When nerves are damaged, they can’t send signals properly, which can result in symptoms such as a burning sensation, loss of feeling, pain or numbness. For patients experiencing traumatic nerve injuries such as brachial plexus and peripheral nerve injuries, immediate evaluation and treatment are required. Neurolysis and nerve grafts are two treatment options offered by Loyola’s expert surgeons.

Nerve sheath tumors — Nerve sheath tumors can be benign (noncancerous) or malignant (cancerous) and affect the function of the nerve causing pain and disability. The two main types of benign nerve tumors are schwannoma and neurofibroma. Sarcomas and malignant nerve sheath tumors are rare and often require radiation and chemotherapy.

How are Peripheral Nerve Injuries and Disorders Diagnosed?

Your Loyola doctor will take a detailed personal and medical history and conduct a thorough physical and neurological examination that focuses on the peripheral nerves. The tests that your doctor orders will depend on your specific condition and may include:

  • Electromyography (EMG)
  • MRI, CT and ultrasound
  • Muscle biopsy
  • Nerve biopsy
  • Nerve conduction velocity test (NCV)
  • Transcutaneous electrical nerve stimulation (nerve conduction study)

How are Peripheral Nerve Injuries and Disorders Treated?

Conservative approaches, including physical therapy and analgesic and nerve-stabilizing medications, are often first-line treatment options for nerve injuries.

However, if surgery is the best option for your condition, you can feel confident that Loyola’s nationally recognized neurosurgery and orthopaedic surgery team will deliver the highest quality of care—from diagnosis to treatment and beyond. Patients with peripheral neuropathy may require a combination of medical and surgical treatments that have proven beneficial. With other conditions, sectioning tendons or muscles can ease pressure on a nerve and greatly reduce or eliminate the pain.

Loyola’s expert surgeons offer the following treatments for nerve injury:

  • Joint immobilization — Your Loyola surgeon may recommend immobilizating the joint with a splint, cast or brace to allow the injured nerve to heal.
     
  • Muscle and tendon transfer — For patients experiencing loss of function, your surgeon may recommend a muscle or tendon transfer, which takes a muscle or tendon near to the impaired nerve and makes a new connection which can restore movement.
     
  • Neurolysis — For patients experiencing nerve pain uncontrolled by more conservative approaches, neurolysis may be recommended. Neurolysis is the destruction of a nerve and can be achieved through several modalities including cryoablation (application of extreme cold), repeated chemical injections, radiofrequency lesioning (use of an electrical current) or neuroablation (application of extreme heat).
     
  • Nerve graft — For patients experiencing a complete loss of muscle function or sensation, your surgeon may recommend a nerve graft, which replaces the injured nerve with a “donor” nerve from elsewhere in your own body.
     
  • Nerve release — For patients experiencing nerve compression due to muscle or connective tissue restricting the nerve (such as carpal tunnel syndrome), your surgeon may recommend a nerve release, which cuts or removes the area of constriction.
     
  • Nerve transfer — For patients experiencing complete loss of function or sensation, your surgeon may recommend a nerve transfer, which takes a healthy nerve proximate to the damaged nerve and reroutes it, bringing sensation and function back to the affected area.
     
  • Prosthetics and mobilization devices — For patients with severe nerve injuries, prosthetics and mobilization devices are available. Nerves from another part of the body may be used to control a prosthetic limb.

Loyola’s highly skilled neurosurgery and orthopaedic surgery teams have access to the most advanced technology and treatments available and will discuss all possible treatment options for your nerve disorder with you. You can feel confident that your Loyola team will guide you through your diagnosis, treatment and recovery with great compassion and expert care.

Meet Our Doctors

Loyola’s Peripheral Nerve Reconstructive Surgery Program takes a comprehensive, multidisciplinary approach to peripheral nerve injuries and disorders. Loyola’s highly skilled anesthesiologists, neurologists, neurosurgeons, physical medicine and rehabilitation physicians, plastic and reconstructive surgeons, orthopaedic surgeons, and vascular and endovascular surgeons have access to the most advanced technology and treatments available. Our specialists include:

  • Douglas Anderson, MD — Dr. Anderson is a neurosurgeon who specializes in dorsal column stimulation for pain management.
     
  • Sonya Agnew, MD — Dr. Agnew is a plastic and reconstructive surgeon who specializes in treating wrist and hand problems.
     
  • Prempreet Bajaj, DO — Dr. Bajaj is a physical medicine and rehabilitation physician who specializes in interventional pain management and electrodiagnostic studies.
     
  • Michael Bednar, MD — Dr. Bednar is an orthopaedic surgeon who specializes in wrist and hand problems.
     
  • Troy Buck, MD — Dr. Buck is an anesthesiologist who specializes in interventional pain management.
     
  • Anna Cooper, MD — Dr. Cooper is an orthopaedic surgeon who specializes in the treatment of patients with sarcoma.
     
  • Paul Crisostomo, MD — Dr. Crisostomo is a vascular and endovascular surgeon who specializes in thoracic outlet syndrome.
     
  • Felicity Fishman, MD — Dr. Fishman is an orthopaedic surgeon who specializes in wrist and hand problems for adults and children as well as brachial plexus injury.
     
  • Matthew McCoyd, MD — Dr. McCoyd is a neurologist who specializes in peripheral neuropathy and electrodiagnostic studies (EMG/MCG).
     
  • Vikram Prabhu, MD — Dr. Prabhu is a neurological surgeon who specializes in  entrapment neuropathy and peripheral nerve tumors.
     
  • Sameer Puri, MD — Dr. Puri is an orthopaedic surgeon who specializes in minimally invasive surgery to treat hand and wrist conditions, including nerve injuries and disorders.
     
  • Adam Schiff, MD — Dr. Schiff is an orthopaedic surgeon who specializes in foot and ankle injuries.

Physical and Occupational Therapy

In concert with your physicians, Loyola’s physical and occupational therapists provide additional support, greatly improving your functional movement and restoring your ability to perform the tasks of daily living. Physical therapy may be helpful in maintaining strength, mobility, and function regardless of the underlying cause of peripheral neuropathy. Occupational therapy is instrumental in helping a patient cope with the functional, vocational, and social impact of peripheral neuropathy.

The following peripheral nerve conditions can be improved with physical and occupational therapy:

  • Anterior interosseous nerve
  • Brachial plexus injuries
  • Carpal tunnel
  • Cervical radiculopathy
  • Cubital tunnel
  • Foot drop
  • Lumbar radiculopathy
  • Posterior interosseous nerve
  • Sciatica
  • Thoracic outlet
  • Vestibular neuritis​

Your physical and occupational therapists aim to:

  • Improve sensory-motor skills
  • Teach patients to avoid exposure to environmental or industrial toxins
  • Teach self-care activities
  • Help the patient navigate safety issues, (e.g., paying more attention to the terrain when walking because falling or tripping may pose a risk for patients)
  • Teach the patient to pay attention to issues which involve automatic functions
  • Maintain and improve functions through a range of motion
  • Strengthen muscles – this includes exercising against increasing resistance, use of weights, and isometric exercise
  • Improve balance and posture to provide stability and prevents falls

Prosthetic and Assistive Devices

Loyola’s Peripheral Nerve Reconstructive Surgery Program provides prosthetic and assistive devices for patients with extremity amputation, severe nerve injury or limb deficiency. Prosthetics (prosthetic limbs) and orthotics (braces) are custom-designed for the anatomy, needs and preferences of every patient. These may enable an individual to ambulate with improved efficiency, complete functional tasks, prevent injury, or enable an individual to heal following an injury.

Prosthetists and orthotists work with the patient’s healthcare team to develop and implement a treatment plan for each patient’s needs. The specialists at Loyola can adapt or alter a patient’s device to meet their changing functional needs as healing and recovery occurs.

Services provided:
  • Specialized prosthetic limbs
  • Custom spinal braces: post-operative and post-trauma
  • Protective helmets
  • Custom or prefabricated positional upper/lower extremity braces for contracture management
  • Custom functional lower extremity orthoses
  • Functional electronic stimulation devices including WalkAide, Bioness and Myopro
  • Orthotist/prosthetist clinical evaluations and recommendations

The Loyola prosthetic and orthotic lab is located in the Outpatient Center, and is staffed on Mondays, Wednesdays, and Fridays.  Appointments may be facilitated through your Loyola care team or by calling 708-383-2257.