Florida Neuropathy Center

Serving Patients in Jacksonville, Florida

What is Peripheral Neuropathy?

Peripheral neuropathy is the term for damage to the nerves of the peripheral nervous system (any nerve outside of the brain and spinal cord). Neuropathy may be caused either by diseases of the nerve or from the side-effects of systemic illness. Systemic illnesses such as diabetes, even "pre-diabetes," and thyroid disorders can lead to neuropathy symptoms. Other causes such as chemotherapy, arthritis, vitamin deficiencies, heavy metal toxicity, drug-induced, leprosy, and alcoholism can lead to neuropathy.

What are common neuropathy symptoms?

Typically the hands and/or feet are affected with symptoms of painful burning, tingling, numbness, cramping and/or weakness. Sometimes this distribution of symptoms is referred to as the "stocking & glove" pattern. A common description from a patient with neuropathy is that "I awaken at night with a burning, cramping pain in my foot that I cannot shake or wring out".

Can Neuropathy be treated surgically?

If your neuropathy is classified as a "compressive neuropathy," then you may be a candidate for surgical treatment. One of the main types of neuropathy, or "compressive neuropathy," is due to focal pressure on a nerve. Nerves pass through fixed openings all over our body that allow for a certain space for the nerve to pass through. When a nerve is swollen as occurs due to the metabolic effects of high blood sugar in diabetes, pre-diabetes, or thyroid disorders it can become compressed at these fixed openings. A compressed nerve is not only tender at the site of compression but can lead to overall pain and numbness in the affected extremity. By surgically decompressing, or relieving pressure on the intact nerve, pain may be decreased and sensation can return. In the legs returning protective sensation is critical as it may prevent ulcer formation and ultimately prevent amputation. During peripheral nerve decompression surgery, the nerve is NOT cut. A common example of this is carpal tunnel syndrome in the upper extremity and tarsal tunnel syndrome in the lower extremity.

What are non-surgical treatments for neuropathy?

If you suffer from neuropathy you must see your primary care physician first to determine if the underlying medical condition can be treated to relieve your neuropathy symptoms. If medical management does not alleviate your neuropathy or you are not a surgical candidate, a pain management specialist may offer alternatives to help with your pain.

 

The process

Am I candidate for neuropathy surgery?

The first step in our comprehensive treatment of peripheral neuropathy, is to establish a diagnosis and work with your primary care physician, endocrinologist, neurologist to ensure that any underlying medical disease is adequately being treated. We will perform a comprehensive neurosensory examination of the affected limb to determine if you suffer from a "compressive neuropathy" that can be surgically treated.

I have a compression neuropathy, what is the next step?

Prior to the initial consultation:

• Schedule a consultation with our surgeons
• Complete our peripheral neuropathy questionnaire
• Obtain your records from prior treating physicians outlining previous treatment or diagnostic studies pertinent to your peripheral neuropathy

What is done at the initial consultation?

The initial consultation steps:

• Our surgeons will review your history with you, perform a physical examination, and answer all your questions and concerns
• Our surgeons will identify if a focal compression site is present and surgically treatable to relieve your neuropathy symptoms.

Now that I am a candidate for neuropathy surgery, what does surgery entail?

Surgery is performed under general anesthesia under supervision of a board certified anesthesiologist.

For most patients, surgery is performed on an outpatient basis (you go home the same day). Depending on the number of focal compression sites treated, surgery takes 1 to 2 hours to perform. During peripheral nerve decompression surgery, the nerve is NOT cut.

What should I expect during my neuropathy surgery recovery?

Following surgery until the first visit (usually 7 days) we encourage patients to relax, elevate the operated limb, and not perform any strenuous activity. A compressive dressing is placed on the arm or leg until it is removed in the follow up visit. If the leg was operated on, a walking boot is typically used to allow for limited walking as initial elevation of the limb is imperative. Activity is gradually increased and most patients are back to work and normal activity within 2-3 weeks. You are not able to drive or operate heavy machinery while taking any post-operative narcotic pain medication.

Some patients experience immediate pain relief, others it can take several months to a year depending on the amount of compression and the degree of nerve damage from the compression.

All sutures, except those used for the ankle, are typically dissolvable and do not require removal.

As peripheral nerve decompression relieves chronic pressure on the damaged nerves some patients may experience shooting, stabbing or electrical types of pain as their nerves are healing. This is a good sign showing the nerve is regenerating and can usually be treated with topical and or oral medication until the sensations subside.

What is the success/risk of peripheral nerve decompression for neuropathy surgery?

Our goal is to reduce your pain, restore your sensation which will help with balance and protect you against ulcer development that would otherwise lead to amputation. Many patients are able to decrease or stop taking their medications related to neuropathy pain after the procedure.

Other than the typical risks of general anesthesia & surgery, the main risk for this procedure is that you may still have areas of pain and/or numbness following your procedure.