Nerve Decompression Frequent Questions

Exertional compartment syndrome causes severe muscle pain and cramping in the legs, making it difficult for athletes and those interested in high-intensity activities to participate due to pressure in the muscle compartment. Symptoms may stop with rest but can intensify when doing an activity.

While modifying or avoiding certain physical activities may help with exertional compartment syndrome for some patients, others may require surgery to correct the underlying issue so they can get back to the activities they enjoy. Find out more about the different approaches—such as a nerve decompression or nerve release surgery—that Dr. Williams may recommend to treat this condition.

Treating Exertional Compartment Syndrome

There are both non-surgical and surgical approaches used to treat exertional compartment syndrome. Conservative treatments may include resting or changing from a high-intensity activity to one that is low-impact to provide relief. In addition, using pain medication or wearing custom orthotics can also help to minimize symptoms.

For those who are athletes, non-surgical options may not be the solution since modifying or avoiding an activity will make it difficult to compete in the sport they enjoy. The symptoms may ease up when resting but flare up again when the person returns to the activity.

Dr. Williams can evaluate the condition to confirm that it is exertional compartment syndrome and not another condition such as shin splints that is causing the pain. Once a diagnosis is made, Dr. Williams will recommend treatment based on the patient’s specific needs. Some options used to treat exertional compartment syndrome include:

• Fasciotomy. This surgical procedure is the most effective treatment of chronic exertional compartment syndrome. It involves cutting open the inflexible tissue encasing each of the affected muscle compartments to relieve pressure.
• Nerve release surgery. This type of surgery is done to free nerves that are compressed by the affected muscles. It may be done in addition to a fasciotomy or on its own.

Contact Dr. Eric H. Williams for Help

Don’t suffer from the symptoms of exertional compartment syndrome any longer. Our goal is to help ease your symptoms and get you back to enjoying your favorite activities as soon as possible. To schedule an appointment in the Baltimore office, contact us at (410) 709-3868 or fill out our contact form online.

Related Links: Solutions for Exertional Compartment Syndrome in Runners Treatment of Exertional Compartment Syndrome Differences Between Shin Splints and Compartment Syndrome

A branch of the optic nerve that provides sensation to the scalp is the supraorbital nerve. The supraorbital nerve can become compressed in various ways and cause migraines. Finding relief for migraines can be a challenge for many patients. One option to consider is nerve decompression surgery to remove anything that is irritating the nerve and causing the headaches. Many patients find this option to be successful in eliminating their migraine pain. Our peripheral nerve surgeon can determine if this is an option for your specific condition.

Options for Treating Migraines

Migraines can be caused by a variety of factors. One potential cause is compression of the supraorbital nerve, which causes migraine pain in the forehead above the eye. This type of nerve compression can be due to trauma, plastic surgery, or a viral infection. When the supraorbital nerve is compressed, it can cause migraine pain that is sharp, shooting, and tingling.

To treat migraines due to supraorbital compression, a peripheral nerve surgeon may recommend the following:

• Supraorbital nerve block. A block can be placed directly into the supraorbital nerve. This can provide temporary relief from certain types of migraine pain.
• Nerve decompression surgery. Surgery can be done using small incisions above the eyebrow to remove muscle, tissue, or blood vessels that are compressing on the supraorbital nerve. It is done as an outpatient procedure under general anesthesia and takes under three hours.

Dr. Williams has performed nerve decompression surgery on patients with migraines caused by supraorbital nerve compression. This procedure was so successful for one of his patients that she was able to stop her migraine medications and no longer experiences debilitating migraine symptoms. Surgery has cured her migraines, and she is able to resume her daily activities after suffering from years of chronic migraine pain.

If you have questions about supraorbital nerve decompression and whether it can relieve your migraine pain, contact Dr. Williams for an evaluation. To schedule an appointment in the Baltimore office, contact us at (410) 709-3868 or fill out our contact form online.

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The brachial plexus is a network of five nerves that control muscle movements and sensation in your hand, arm, and shoulder. An injury to the brachial plexus can result in muscle weakness, loss of sensation, or paralysis of the shoulder and upper limb muscles. If the injury is mild, it may heal on its own and not require treatment, but for more severe injuries, a nerve specialist may recommend nerve decompression surgery to help regain function of the hand or arm.

Causes and Symptoms of a Brachial Plexus Injury

There are many causes of a brachial plexus injury. An injury to the brachial plexus occurs when there is forceable pulling or stretching of the arm, and the head is pushed in the opposite direction. This type of injury can be the result of the following:

• Fall
• Automobile or motorcycle accident
• Knife or gunshot wound
• Cancer treatment

Symptoms of a brachial plexus injury typically affect the hand and arm and may include:

• Sudden pain
• Muscle weakness
• Numbness
• Loss of sensation
• Burning or stinging
• Paralysis

Treatment Options

Surgery is not the first option for treatment for a brachial plexus injury since this type of injury can sometimes recover on its own. In addition to giving the injury time to heal, conservative treatments such as the following may be used:

• Pain medications
• Corticosteroid creams
• Injections
• Physical therapy exercises

If the nerves do not heal on their own, surgery may be recommended. Surgery options for a brachial plexus injury may include:

• Nerve repair to reconnect the torn edges of the damaged nerve
• Nerve graft using a healthy nerve from another location to connect the ends of the separated nerve to help with healing
• Nerve transfer to attach an inferior but functioning nerve to the damaged nerve to allow for new nerve growth
• Tendon or muscle transfer if surgery cannot be performed to repair the damaged nerves

If surgery is done for the injury, it can take time to see results. Since nerves only grow about one inch per month, it can take several weeks or months to notice improvement. During this time, you may need physical therapy and regular appointments with your nerve specialist. As you recover, the pain will diminish, and you should regain strength and sensation in your hands and arms.

Dr. Williams has been successful in using nerve decompression surgery on patients with a brachial plexus injury. If you have questions about surgery for a brachial plexus injury, contact Dr. Williams for an evaluation. To schedule an appointment in the Baltimore office, contact us at (410) 709-3868 or fill out our contact form online.

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One of the most common causes of peripheral neuropathy is diabetes. However, this type of nerve damage can also be the result of a traumatic injury. 

Peripheral neuropathy causes sharp, stabbing pain, tingling, and numbness in the feet and hands. It can make it difficult to walk or keep your balance. The type of treatment recommended for peripheral neuropathy depends on the root cause of the condition.

Causes of Peripheral Neuropathy

Traumatic peripheral neuropathy can occur from the following:

• Automobile accident
• Slip and fall
• Sports injury
• Medical procedure

These types of injuries can compress or stretch the nerves or detach them from the spinal cord. A slipped vertebrae disk or broken or dislocated bones can also cause pressure on nearby nerves and nerve fibers resulting in peripheral neuropathy.

Treatment Options for Peripheral Neuropathy

If you are experiencing nerve pain from peripheral neuropathy, consult with Dr. Williams for diagnosis and treatment options. To diagnose the condition, the following may be done:

• Physical and neurological exam
• Blood tests
• Imaging tests such as a CT scan or MRI
• Nerve function tests
• Nerve biopsy

Without proper treatment, peripheral neuropathy symptoms can last for months or years and gradually worsen over time. The goal of treatment is to reduce symptoms and improve pain by allowing the nerves to heal. When peripheral neuropathy is caused by an injury and not from diabetes, treatments such as medication or lifestyle changes may not prove effective in providing relief.

Nerve decompression surgery is an option to consider if peripheral neuropathy is interfering with your daily activities and cannot be controlled by conservative methods. Surgery is done to release pinched or compressed nerves that are causing pain and symptoms. The type of procedure done will depend on the root cause of the condition and the specific nerves that are affected.

To schedule an appointment with Dr. Williams to discuss peripheral neuropathy treatment options, contact us at (410) 709-3868 or fill out our contact form online.

Related Links: Is Peripheral Nerve Surgery Safe? Ankle and Foot Pain   When Do I Consider an Operation for a Nerve Problem?

 

Even though occipital neuralgia is not a life-threatening condition, it can have a serious impact on your overall quality of life. It can cause pain that interferes with daily activities and may prevent you from enjoying time with family or friends. 

You can often find relief from the pain caused by occipital neuralgia through various treatments. When conservative treatments fail to bring the necessary relief, occipital nerve decompression surgery performed by a peripheral nerve surgeon can help. 

Treating Occipital Neuralgia

Occipital neuralgia can occur if there is a pinched or damaged occipital nerve that runs from the neck to the base of the skull. It can result in a chronic, intense headache that makes it difficult to do daily activities. While the pain from occipital neuralgia is similar to that of a migraine, the condition itself is more serious since it is nerve related. 

In order to effectively treat occipital neuralgia, the source of the pain needs to be determined. To diagnose the condition and determine if a compressed occipital nerve is the cause of the pain, a nerve block may be done. If the nerve block temporarily provides relief from the pain, it can confirm the diagnosis of occipital neuralgia. 

When conservative treatments such as medication do not provide relief, nerve decompression surgery can be done to release the occipital nerves from muscles or surrounding tissue that are compressing the nerves. This surgery is done as an outpatient procedure and you will be able to go home the same day.

After the occipital release procedure, you may have restrictions to follow for several weeks. These include no heavy lifting or driving a vehicle. You may also feel tired and may need to take pain medication. Headaches from occipital neuralgia should be reduced after the first two weeks but numbness and tingling may be present until the nerves recover from the prior compressed condition.

Find Relief From Occipital Neuralgia

If you have occipital neuralgia and are looking for pain relief options, contact Dr. Williams to discuss if surgery may be the right choice for you. To schedule an appointment in the Baltimore office, call us at (410)709-3868 or fill out our contact form online.

Related Links: Treatment for Head and Neck Pain  Why Finding Help for Pain Is Never a Lost Cause  Help for Migraines

 

When you sprain your ankle, the pain you feel generally falls into the category of orthopedic pain—which simply means it is related to the muscles, bones, and connective tissues in and around your ankle.

Neuropathic pain is different. Pain is said to be neuropathic if it is caused by injured, stretched, or compressed nerves. You may experience neuropathic pain as a result of an ankle injury or after ankle surgery. This sort of pain is generally chronic—meaning it lasts for more than six months after an injury or surgery.

Symptoms of Neuropathic Pain 

When asked to describe their pain, our patients have used some striking comparisons:

• It feels as though you are walking on sharp rock or shards of glass.
• It feels as though bees are stinging or fire ants are biting your foot constantly.
• It feels as though your entire foot is wrapped in barbed wire.
• It feels like a serious sunburn on the top of your foot.
• It feels like an electric current is shooting down your leg.

In addition, you may experience discomfort or pain (often severe) simply because you are wearing shoes or socks—or even when your foot is touched by something light like a bedsheet.

Sometimes the Solution Is Surgery for Your Neuropathic Pain

If it is clear that the pain you are experiencing is not orthopedic in nature, it is time to be evaluated for neuropathic pain and to discuss potential solutions.

In some cases, there are non-surgical approaches that might help. In other instances, surgery to release the compressed nerve or otherwise repair nerve damage may be the best solution. 

One thing that is not an option is to simply try to ignore neuropathic pain. It will upend your day-to-day life, keeping you from enjoying your active lifestyle. Finding the best solution for relieving neuropathic pain is essential.

Dr. Williams Can Help You Find Relief. Contact Our Nerve Pain Specialist Today.

Dr. Eric H. Williams is committed to listening to you and to finding the best solutions to address ongoing pain. Known for both his skill as a surgeon and his compassion for his patients, Dr. Williams will make sure you understand all of your options and are comfortable with the proposed solutions. To learn more about neuropathic pain, request our free whitepaper. When you are ready to get relief from your chronic pain, contact us to make an appointment. 

Related Links: Why Is My Ankle Still Hurting? What a Patient May Expect From Nerve-Related Ankle Surgery

Superior cluneal nerve entrapment is hard to diagnose and is often misdiagnosed as sciatica.

If you are experiencing pain in the lower back and buttock, it may be related to a problem with a nerve. The nerve may be the sciatic nerve, which is located fairly low on the body beneath the sacrum and pelvic bone. Or it may be the cluneal nerve, which is located outside the spot where the sacrum and pelvic bone come together. 

Okay, so two different nerves in two different spots. So far, so good.

But brace yourself for another unusual word: the cluneal nerve travels through a fibro-osseus tunnel (we warned you!) tunnel. That tunnel is not unlike the carpal tunnel in the wrist and the cluneal nerve is not unlike the median nerve. That is to say: just like the median nerve can get squeezed in the carpal tunnel, the cluneal nerve can get squeezed in its fibro-osseus tunnel.

The result is easy to understand: pain.

Diagnosis of Superior Cluneal Nerve Entrapment Is All About Location

We’ve noted the different locations of the sciatic nerve and the cluneal nerve. Those different locations mean they can cause pain in different parts of the body. Sciatica generally involves pain in the lower part of the buttock radiating down the back of the leg. Superior cluneal nerve entrapment generally involves pain in the lower back through the buttock—but not into the leg.

Superior Cluneal Nerve Entrapment or Sciatica?

It is often misdiagnosed as sciatica, but also SI joint dysfunction, arthritis, and lumbar spine degenerative disease. It is very important and even needed for the patients to have a differential diagnosis explored by their physician. They can try to compare the results of different blocks that they have and their effect on their pain. It is important not to let the doctor tell the patient if the block was successful.  It is important that the patient tell the doctor if it worked or not. Because spinal joint disease is so common, we frequently only see what we know. So, if someone has "an okay" response with one injection, but a superior cluneal nerve block is not tried to compare the result to the facet block or the epidural injection, or nerve root injection, or SI joint injection, then the patient may miss the opportunity to compare the results. They may actually find out before they have a failed spinal fusion or laminectomy, or SI joint fusion, that the superior cluneal nerve may actually be the culprit. It is also very possible that the patient may have both! This does happen more than we think, and it is one reason why patients may not see the results they wanted with one diagnosis is completely treated. If they are still having pain after spinal fusion or SI joint fusion, the patient can either "accept" the outcome or keep looking. One of the things to look for is compression or injury to the superior cluneal nerves. 

The nerve is located lateral to midline, at the low back, and crosses only into the upper buttock, though it can radiate down as far as the posterior hip. Patients may be able to find it themselves by pressing at the low back at the location of their posterior pelvic bones.

Let’s Talk About Ablation

If physical therapy, stretching, heat, ice, anti-inflammatories, and conservative measures do not help, and nerve blocks of the superior cluneal nerves have provided good evidence that this is the cause of pain, then ablation of the nerves is an option. There are several ways to ablate these nerves. Some pain management teams will "burn" the nerves with radiofrequency ablation; some may freeze them with cryoablation. This is great when they work. The only problem I have seen with these modalities is trying to cover all of the anatomic variations of where these nerves are located. So, we prefer as surgeons to take a more direct approach: surgical resection. We prefer surgically exploring the region, finding the nerves, no matter where they are located, and surgically removing them. We have seen many variations in the anatomy which can easily explain why the RFA and Cryo approaches may not be as successful in some patients as others. While the surgical approach is more invasive, it tends to provide a much better view of these nerves than the current imaging modalities such as ultrasound. Because this is essentially an operation on the skin, recovery tends to be rapid.  

 

Other options for treatment may include "electrical stimulation." Some may try to "stimulate" the nerve to try to stop hurting with peripheral or spinal cord stimulators.  Again, due to the same anatomic variations that can make the ablation procedures challenging, this makes the result of stimulators challenging as well.  Also, these techniques require the permanent implant of a foreign body in the lumbar region which many patients would like to avoid. 

Get the Right Diagnosis and Clarity About Treatment

We understand that just reading this FAQ may have given you a headache—so here’s the long and short: if you are having pain in your posterior, you need to get the right diagnosis so that you can get the correct treatment. Dr. Eric H. Williams can diagnose the specific cause of your pain and explain the best course of action to correct the problem. Contact us today so that we can get started putting a stop to your pain.

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