Baltimore Peripheral Nerve Surgeon Dr. Eric H. Williams Provides Surgical Solutions for Chronic Nerve Pain
Whether from injury, surgery, or an underlying condition, nerve pain can be debilitating. Fortunately, treatment is available. Baltimore peripheral nerve surgeon Dr. Eric H. Williams has helped many patients with chronic nerve pain find relief—and he may be able to do the same for you.
How Would You Describe Your Symptoms?
Describing your symptoms clearly and accurately is the first step to helping Dr. Williams determine if a peripheral nerve problem is the cause of your chronic pain.
Using descriptive language is essential. Instead of using vague terms like "pain" or "numbness," provide details about the type of sensation you're experiencing. For example, our patients with severe meralgia paresthetica often say the pain feels like:
- “Battery acid down my leg”
- “Little tiny soldiers with knives stabbing the outside of my thigh”
- “Someone has plugged my thigh into an electric socket”
- “A hive of bees on my thigh”
- “Bugs crawling on my skin”
- “Water dribbling down the thigh”
Descriptive language includes pinpointing the exact location of your symptoms, such as a specific area of the arm, leg, hand, or foot. If the symptoms radiate or spread, describe the path they follow. Believe it or not, the hand, foot, leg, or other body part can actually be pretty big. There are lots of parts. For instance, many patients complain that their “foot hurts.” But what they really mean is that the “bottom of my big toe feels like it is on fire”, or the “top of my foot feels like electricity is running through it, and it comes from the side of my knee right to the top of my foot”, or even “I feel like I am stepping on a thumb tack every time my heel touches the ground.”
Did you catch that? Yes, all of these patients have pain in their feet, but it is NOT just their feet. The pain is in a specific part of their feet.
This also applies to pain in the thigh, headache, pelvis, buttock area, and arm. The location of a patient’s pain is very important; it is a real clue as to what is going on, so be as specific as possible about the location of the pain.
It is also important to note any activities, movements, or positions that worsen or improve your symptoms. For example, our patients with superior cluneal nerve entrapment often find that lying on their back to sleep intensifies the pain and that bending over puts traction on the nerve that results in searing pain.
Other tips to help you describe your symptoms include:
- Describe the timing. Explain when the symptoms started, whether they are constant or intermittent, and if they vary in intensity throughout the day or night.
- Rate the severity of your pain. Use a numerical scale (e.g., 0 to 10) to rate the severity of your symptoms, with 0 being no discomfort and 10 being the worst possible discomfort.
- Include descriptions of altered sensation. Many patients with nerve damage report loss of normal sensation to touch. This touch may be functional touch – meaning that the patient may have numbness, but it can also be sensations that occur when the patient is lightly touched; this can be very painful such that normal actions such as wearing paints, putting on shoes, or having bed sheets draped over their legs can be incredibly painful. Changes in sensation, which are sometimes referred to as dysesthesia, are an indication that your nerves aren’t working as they should.
- Movement and strength. It is important to note and describe if you have any weakness or loss of movement in the area of pain. For example, some patients with severe tarsal tunnel syndrome in the foot may not be able to spread their toes apart very well, and it can be very different than the other foot. Some patients with carpal tunnel syndrome may see profound muscle loss in the base of the thumb if they let the problem go on too long. These are clues for the physician to help make more accurate diagnoses of the cause of your symptoms.
Do You Have a Positive Tinel’s Sign?
A Tinel's sign is a clinical test for potential nerve irritation, compression, or injury. It involves tapping over the path of a nerve to elicit a tingling, electrical, or radiating sensation in the distribution of that nerve. While this test is certainly not “foolproof,” it is an important sign for the peripheral nerve surgeon.
A positive Tinel's sign indicates some degree of nerve irritation, compression, inflammation, or injury at the location being percussed. It suggests the nerve is being compressed or disrupted in its normal functioning.
The test gets its name from Jules Tinel, the French neurologist who first described this physical examination technique in 1915 to evaluate nerve injuries and regeneration. It is sometimes referred to as the Hoffmann-Tinel sign.
Dr. Williams may ask if you have a positive Tinel sign at your appointment. However, being unable to find a positive Tinel sign at home doesn’t necessarily mean you aren’t suffering from a peripheral nerve problem. It is just one diagnostic tool and not a substitute for an inpatient in-person visit.
Common Peroneal Nerve Self-Exam
The common peroneal nerve is a branch of the sciatic nerve that runs down the outer side of the knee and supplies sensation and movement to the top of the foot and toes. Compression or injury to this nerve can cause symptoms like numbness, tingling, burning, weakness, or foot drop (inability to lift the foot).
Tarsal Tunnel Syndrome Self-Exam
Tarsal tunnel syndrome is a compression of the tibial nerve in the inner ankle area. This nerve supplies sensation to the sole of the foot, heel, arch, and toes. Patients with tarsal tunnel syndrome may experience numbness, tingling, burning, hypersensitivity, or pain in any part of the sole.
When Did Your Pain Start?
Damage to the peripheral nerves can occur in multiple ways but is often the result of trauma. For example, Dr. Williams often sees patients with damage to the lateral femoral cutaneous nerve as a complication of anterior hip replacement surgery damage to the ilioinguinal, iliohypogastric, and genitofemoral nerves from hernia surgery, injury to the infrapatellar branch of the saphenous nerve after total knee replacement, or failure to improve after removing a Morton’s neuroma.
Persistent post post-surgical pain doesn’t necessarily mean your surgeon was negligent. All surgery involves some form of risk and complications can result regardless of a surgeon’s level of skill and experience. Dr. Williams can provide more information about whether your nerve damage could be a complication from a past surgery at your initial appointment.
In addition to nerve damage caused by surgery, Dr. Williams often sees people who have peripheral nerve compression after a car crash, work injury, or sports-related accident. Fractures, dislocations, blunt trauma, crush injuries, lacerations, and internal bleeding all have the potential to result in damage to your peripheral nerves.
Any information you can provide about when your pain started can help Dr. Williams recommend the best possible course of treatment.
What Treatments or Diagnostic Tests Have You Tried?
At your appointment, Dr. Williams will ask you what treatments you’ve tried to relieve your pain and what diagnostic tests have been performed by other health care providers. Be prepared to provide records for any of the following:
- MRI. This imaging technique uses strong magnetic fields to produce detailed images of the body's internal structures, including nerves and areas of potential nerve compression.
- MRN (MR Neurography). This specialized MRI technique is optimized for visualizing peripheral nerves along their entire course to detect areas of injury, compression, or abnormalities.
- EMG. Electromyography involves inserting small needles into muscles to measure electrical activity and assess nerve function and any denervation or nerve damage.
- X-ray. While X-rays don't directly image nerves, they can help visualize bony structures that may be compressing or impinging on nerves.
- Medications. Certain medications like anti-seizure drugs, antidepressants, or anti-inflammatory drugs may help reduce nerve pain and inflammation.
- Physical therapy. Specific exercises and therapies can help strengthen muscles, improve nerve gliding, and manage symptoms of nerve impingement or compression.
- Steroid injection. Injecting corticosteroid medication around an inflamed or compressed nerve can reduce swelling and alleviate symptoms.
- Nerve block/injection. Injecting an anesthetic or anti-inflammatory medication directly around the affected nerve can diagnose the source of pain and potentially provide therapeutic relief.
- Relevant doctor’s notes and records. We often need to evaluate what has been done, what others are thinking, and verify patient reported findings, history, and events. It is nearly always necessary to gather notes from important doctor’s visits. We will frequently review them.
Do You Want to Have Surgery?
As a peripheral nerve surgeon, Dr. Williams focuses on the following:
- Nerve decompression. Nerve decompression is a surgical procedure that aims to relieve pressure on a compressed nerve by removing or cutting through any structures, such as bone, muscle, or scar tissue, that are compressing and irritating the nerve.
- Nerve repair. When a nerve has been severed due to injury or trauma, nerve repair surgery involves meticulously reapproximating and suturing the two ends of the nerve back together in an attempt to restore continuity and function.
- Nerve resection. A nerve resection is a procedure where a segment or portion of a nerve is surgically removed, typically done when the nerve is irreparably damaged or dysfunctional and resection may help alleviate symptoms like severe, unremitting pain.
Dr. Williams does not treat patients who do not wish to consider surgical solutions for their chronic pain. As part of our intake process, you’ll be asked whether you’re looking to have surgery as soon as possible, within three months, or in more than three months.
If you have NO desire to consider a surgical option to help relieve pain, we would strongly recommend that you search out a skilled physical therapist and a good “MEDICAL” pain management team who may have less invasive options. Medications, implantable stimulators, and other techniques which could be beneficial. If these fail, we are happy to discuss what options we may have available for your treatment. Not every patient will need an operation.
