UAB offers innovative approach for nerve trauma and compression

Neurolysis of scarred nerves and reinnervating damaged peripheral nerves with autologous grafts may help restore function in patients suffering from traumatic nerve damage. The intervention also is used to relieve chronic pain in individuals with certain types of neuralgia or neuritis.

“Patients with peripheral nerve problems may be unaware of their options for surgical nerve interventions to improve motor and sensory functions,” says UAB orthopaedic surgeon Richard D. Meyer, MD, one of few neurologic, vascular, orthopaedic, and plastic surgeons nationwide applying advanced techniques to reroute peripheral nerve pathways critical for daily function.

“Patients are sometimes surprised to learn that an orthopaedic surgeon specializes in nerve surgery, but this focus has progressed from my work repairing peripheral nerves in hands to restore function and relieve weakness and pain,” says Meyer, who performs peripheral nerve surgery about once a week. The majority of UAB patients who undergo nerve surgery report significant symptomatic relief.

Meyer frequently repairs acute peripheral nerve injuries using the surrounding healthy nerves. However, when patients present several months following injury, and remyelination has failed to occur, surgeons must fill the resulting nerve gap.

“We typically fill gaps using short nerve pieces, either a single strand or a cable,” he explains. “Depending on the repair site, it may be more efficacious to take a functional nerve from elsewhere and transfer it. For example, I can transfer a triceps nerve branch to the axillary nerve to obtain deltoid function. Patients experience a small triceps deficit but have restored deltoid function.”

In addition to patients who have experienced acute nerve injuries, those suffering from compression neuropathies following trauma, inflammation, or entrapment also may benefit from peripheral nerve intervention.

“People who have lost function due to thoracic outlet syndrome and compressive neuropathies find decreased pain and restored function significantly improve their quality of life,” he says, adding that UAB has expertise evaluating neuralgia and neuropathy in patients with uncontrolled pain for potential nerve grafting or for diagnosis and treatment of an underlying cause.

Early Intervention

Reinnervation depends on sensory fibers reaching their sensory end organs and motor fibers contacting their muscle targets. Open or penetrating injuries, blunt traumas, and other acutely damaged nerves may respond dramatically to surgical nerve grafting, but Meyer notes that after about 9 months, damaged muscles will no longer function even if the associated nerves are repaired.

“Some traumas, such as crush injuries, may benefit from waiting for several weeks prior to surgical intervention so we can assess precise degrees of denervation with electrodiagnostic studies,” he says. “Still, it is imperative to evaluate peripheral nerve injuries early, when we have an opportunity to provide a comprehensive range of effective treatment options.”

For more information
Dr. Richard Meyer
1.800.UAB.MIST
mist@uabmc.edu