Peripheral Nerve Surgery

You may know that Dr. Mesiwala operates on brains and spines. However, he also completes surgeries for peripheral nerve disorders as well.

Dr. Mesiwala in surgery.

A well-known example of this is carpal tunnel. You may classically hear of friends or colleagues who spend hours typing on their computers and over time develop numbness and discomfort in their hand(s). As providers, we will often hear these patients say their numbness wakes them up at night or that shaking their hands will help relieve the symptoms. We may even see atrophy of the muscle at the base of the thumb, called the thenar eminence. During the physical exam, we will repetitively “tap” on a peripheral nerve (in this example, the median nerve at the wrist) in what we call a “Tinel’s sign/test.” If this tapping results in numbness, tingling, or pain then this is a positive exam finding. We will then confirm this with a nerve study, or EMG/NCV. To fix carpal tunnel syndrome surgically, an incision is made at the wrist to expose the median nerve. The nerve is then decompressed by releasing any surrounding tissue including scar tissue, adhesions, or perineural fibrosis. This is done with great care so as to not harm the nerve but to allow it to become completely mobilized and not compressed. This relieves the pressure and subsequently the numbness and pain.

Overhead shot of the Mesiwala team in surgery.

However, there are many peripheral nerve disorders. Just recently Dr. Mesiwala performed a decompression of the left lateral femoral cutaneous nerve along the inguinal ligament. This patient had a persistent sharp pain in his left groin area that could not be explained by any other diagnosis. Dr. Mesiwala was able to free up the nerve from the tight capsule of tissue surrounding it. A few days after surgery, the patient excitedly shared that he no longer had the sharp stabbing pain that he had prior to surgery. 

These may not be big or extensive cases, as they are often less than 30 minutes, but they still have a very rewarding outcome. 

Dr. Mesiwala and team in surgery.

There are some patients who have peripheral nerve pain that cannot be fixed with decompressive surgery. For example, we see patients who have refractory superior cluneal nerve pain or pain along the posterior iliac crest of the pelvis. In these cases, we may recommend a peripheral nerve stimulator. 

Dr. Mesiwala’s experience and understanding of the central and peripheral nervous system allows him to make an expert diagnosis. Do you suffer from a peripheral nerve disorder? I bet we can help! Visit us at www.drmesiwala.com.