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Published on January 22, 2018

businesswoman with wrist pain

Getting Rid of Nerve Pain – For Good

Pain. Numbness. Tingling. Uncomfortable feelings of “creepy crawlies” or walking on pebbles or fire. No one wants to live with symptoms like these, but many people have for a number of years, never hoping that it could get better.

Many of these symptoms point to nerve problems for which there are solutions, said Emran Sheikh, MD, with Avera Orthopedics.

Sheikh is an orthopedic surgeon with special interests in nerve reconstruction, minimally invasive surgery and adult/pediatric hand and wrist surgical and non-surgical care.

“There are tunnels everywhere for nerves. There are up to six tunnels for each nerve,” he said. Examples include the carpal tunnel at the wrist or the cubital tunnel at the “funny bone” or inner elbow. “The trick is to find out what nerve is involved and what tunnel. The longer it’s been going on, the more likely it’s multiple nerves and multiple tunnels.”

Nerve compression is the issue. Nerves within the tunnels become compressed by surrounding tissues, such as inflamed and swollen muscles, tendons, ligaments and connective tissue, as well as scar tissue.

A common theme is “this has been going on for years,” Sheikh said.

There are various diagnoses for pain including fibromyalgia, frozen shoulder, tennis elbow, diabetes neuropathy, or restless leg syndrome. Pain attributed to these diagnoses may in actuality be undiagnosed nerve compression. “If there’s numbness and tingling, we have to think nerve,” Sheikh said.

There’s no objective test like MRI or CT for nerve compression, Sheikh said.

“The nerve conduction test and electromyogram is close,” he said, but it doesn’t always give a complete picture.”

One such example is “double crush phenomenon.” This is when a nerve is pinched in two spots, like a garden hose that is kinked in two places. The nerve test may not pick up on the effects of both points. “If a nerve test shows mild disease but symptoms are not mild, there’s another level where the nerve is getting pinched. It comes back to a pattern of symptoms and the exam the doctor does to diagnose the condition,” he said.

Nerve compression can happen at many points in the body, but there are likely spots:

  • Thoracic outlet at the base of the neck, causing numbness or tingling in your arm or fingers; pain in the neck, shoulder or hand; or a weakened grip. Poor posture over time is one cause of compression in the neck and shoulders.
  • Carpal tunnel, causing tingling and numbness in your fingers or hand, usually the thumb, index, middle or ring fingers.
  • Cubital tunnel, causing pain and numbness in the elbow; tingling, especially in the ring and pinky fingers; decreased dexterity; or decreased grip.
  • Sciatica, which causes pain in the buttock and down the leg and a feeling that your leg “gives out.”
  • Peroneal nerve compression, which causes tingling in the top of the foot or the outer part of the shin, inability to hold the foot up, dragging toes and walking problems.
  • Tarsal tunnel at the ankle, which causes pain, numbness or tingling back of the calf and/or on the bottom of the foot. Sensations may extend to the heel, arch, toes and calf. Symptoms are often described as restless legs, “creepy crawlies,” or a feeling of walking on pebbles or fire.

“Plus, there are nerves going up from the neck into the head, and compression in these tunnels can cause headaches,” Sheikh said.

Like anything in medicine, more conservative approaches are recommended first, including posture training, physical therapy, or steroid injections.

If these measures fail, a solution is surgery. “This is an outpatient procedure to unpinch the nerve. We open the tunnel by clearing out the tissue that’s causing the compression,” Sheikh said. This is an outpatient procedure under local sedation. “The pain often gets better right away. Numbness may take more time to recover.”

Some conditions can’t be fully reversed in order to regain 100 percent function.

“But if you can gain 60 percent function, that’s function you did not have before and it greatly improves your quality of life,” he said.

Learn more about getting rid of nerve pain.

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