Ask the Expert: Dr. Joseph Feinberg, Physiatric Peripheral Nerve Injury Specialist, Answers Your Questions on Peripheral Nerve Injuries

by Dr. Joseph Feinberg
Dr. Joseph Feinberg, Physiatrist-in-Chief

Q1: I am a competitive volleyball player and have recently noticed some weakness in my “spiking” shoulder. My trainer recommended I see a doctor about it in case it is something serious. Is it possible for volleyball players to suffer from peripheral nerve injury?

Volleyball players can sometimes have an injury to the peripheral nerve that supplies part of the rotator cuff muscles. It is called the suprascapular nerve. This can lead to pain and weakness and should be evaluated by either a doctor who specializes in peripheral nerve injuries or a sports medicine physician. A nerve exam known as an Electrodiagnostic test (EMG) can help identify this problem.

Q2: Are dancers at risk for peripheral nerve injuries?

Dancers can sustain injuries to the peripheral nerves in the feet. Common symptoms are numbness, tingling, or burning pain. Although injuries to peripheral nerves in the feet can lead to weakness in the foot muscles, the weakness may be not be obvious and may be difficult to detect. One type of nerve injury, a neuroma can usually be identified with an MRI or ultrasound.

Q3: Is carpal tunnel syndrome related to peripheral nerve injury or is this kind of injury only a result of accidents?

Carpal tunnel syndrome is a condition that involves the median nerve in the wrist and causes numbness and tingling in the hand usually involving the thumb, index finger, middle finger and sometime part of the ring finger. Symptoms are often worse at night. It can also lead to pain, loss of strength and loss of fine motor skills. The symptoms usually occur over a period of time, sometimes during pregnancy, less commonly from an acute injury and can also result from a number of underlying medical disorders.

Q4: Is surgery the only way to treat peripheral nerve injury?

There are a number of ways to treat peripheral nerve injuries. Surgical decompression is often necessary but there are cases where a cortisone injection, proper splinting or activity modification and some form of occupational or physical therapy may be helpful. Certain traumatic injuries may require surgical repair or even nerve transfers. The causes can vary widely and treatments should be decided on a case by case basis.

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Katherine Cash says:

I have been diagnosed, by nerve study, with tarsal tunnel syndrome. Been doing exercises, wearing orthoatics, had 2 injections, taken medrol dose pak, with minimal pain relief. Pain is often a 7 or 8 on a scale of 1 to 10 by mid day. I have also had patella femoral knee replacement 18 months ago and have had chronic pes anserine bursitis in the same leg/foot. I think all conditions are related in some way, and am confused as to how best to proceed with treatment. My local orthopedic Dr is recommending tarsal tunnel release surgery, but until the whole leg is assessed I am reluctant. I am willing to travel to NYC for assessment and even treatment/surgery if that is my best chance for success and reduced pain.

HSS on the Move says:

Hi Katherine, thank you for your question. Dr. Jonathan Deland, Orthopedic Surgeon, says: “Tarsal tunnel operations have the best chance of success if a cause is determined for the symptoms (i.e., a mass or something that can be seen pressing on the nerve). I would recommend an MRI scan of high quality to determine the cause of the symptoms.” To make an appointment for an evaluation, please contact Patient Referral Service at 877-606-1555 or visit them online at https://www.hss.edu/secure/prs-appointment-request.asp.

Katherine Cash says:

I have a pacemaker so can not have MRI”s. Would a CT scan of foot and ankle tell us if surgery for tarsal tunnel release is my cause of pain? The pes anserine bursitis on the same leg has been extremely bad again in the past few months. I”ve had the bursitis since before my patella femoral replacements, probably 4+ years. If my gait has changed because of the bursa pain, could that have caused the tarsal tunnel to develop? Also, could the fluid that has been in my bursa for so long be pressing on any of the nerves that run down into my ankle where the tarsal tunnel pain is?
I have POTS(Postural Orthostatic Tachycardia Syndrome), it basically means that my blood vessels expand instead of contract when I stand, and my blood pressure does the opposite of what it is suppose to do. This makes it very difficult to treat my orthopedic issues. I am having a hard time figuring out what to tackle first and all the Dr”s I”ve seen in Atlanta want to look at just the knee or just the foot. If I came to Hospital for Special Surgery would I get a combined approach. i also have back issues, lumbar and cervical. Had L5 S1 discectomy 20 years ago and cervical fusion of C5/6 and C6/7 4 years ago. My back Dr. thinks that the nerve damage I have from my back (had a nerve study done this summer) could be contributing to all of my issues.

Who would you recommend I see at your hospital, and how long would I have to stay to determine the best treatment for me?

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