Baltimore Peripheral Nerve Surgeon Eric H. Williams MD Explains How to Tell If Nerve Decompression Surgery May Be an Option for Treating Your Nerve Pain
Are you living with diabetic neuropathy? There may be hope you haven't considered. While it's true that diabetic neuropathy itself may be difficult or impossible to cure completely, many patients diagnosed with this condition may have TWO problems: diabetic neuropathy AND a nerve compression. It may be the compression problem that is causing most, if not all, of the symptoms that bring the patient to the doctor’s office. Treatable nerve compressions are frequently misdiagnosed or simply completely ignored.
Almost all of the emphasis in today’s care environment is focused on the treatment of diabetes, and while this is completely appropriate to aggressively control one’s blood sugars, what happens if the pain, burning, numbness, and tingling do not go away with good sugar control? Is a patient just supposed to give up? Just live with the pain? Live with severe numbness and loss of balance?
If a nerve is compressed, whether the patient is diabetic or not, we can treat it in most patients by decompressing the nerve. If a nerve is pinched, it needs to be unpinched, or it will die. Nerve decompression procedures in the appropriate patient can reduce pain and improve quality of life. The challenging part is trying to determine who is the “appropriate patient.”
Dr. Eric H. Williams, a renowned peripheral nerve surgeon in Baltimore, has helped many well-controlled diabetic patients find relief from pain caused by nerve compressions. Don't let a potentially treatable condition hold you back any longer. Let’s look at some factors that suggest you may be a good candidate for this life-changing surgery.
Positive Tinel Sign
Named after Jules Tinel, a French neurologist who first described it in 1915, the Tinel's sign is a simple yet powerful diagnostic tool for the peripheral nerve surgeon. You can check for positive Tinel sign from the comfort of your own home. Here’s a video tutorial:
When you tap along the path of a nerve, a tingling or "electrical" sensation in the nerve's distribution area indicates potential irritation, compression, or injury. (This is the same “funny bone” feeling you get when you hit your elbow and it shoots into your little finger.)
A positive Tinel's sign suggests that the nerve at the tapped location is experiencing some form of disruption in its normal function. If a positive Tinel sign is present in a diabetic with nerve pain, there is roughly an 85% chance they’re suffering from a nerve compression that can be surgically treated, EVEN IF they have been diagnosed with “diabetic neuropathy”.
However, you don’t necessarily need to worry if you’re not able to reproduce this at home. Sometimes it takes someone with more training than just a video at home to find it. The Tinel sign is just one piece of the diagnostic puzzle that Dr. Williams will consider to determine if you’re a good candidate for surgery.
Good Blood Sugar Control
If you're hoping to undergo nerve decompression surgery, Dr. Williams will want you to have good blood sugar control. This is typically indicated by an A1C of less than 8.5. If you are diabetic or live with someone who has diabetes, you probably know what this means.
The A1C test measures your average blood sugar levels over the past 2-3 months, giving a broader picture of your glucose control than daily finger pricks. An A1C below 8.5% suggests that you've maintained relatively stable blood sugar levels over time.
You might wonder why your blood sugar levels are so crucial when you're dealing with nerve pain. High blood sugar can significantly slow down the wound-healing process. After surgery, you want your incisions to close quickly and properly to reduce the risk of complications. Also, having good sugar control can actually improve the level of compression and reduce the pain and numbness in the hands or feet.
If your A1C is currently above 8.5%, your health care team can work with you to improve your diabetes management before surgery. This might involve:
- Adjusting your medication regimen
- Fine-tuning your diet
- Incorporating more physical activity into your routine
- More frequent blood sugar monitoring
Weight Guidelines
BMI, or Body Mass Index, is a simple measure that uses your height and weight to work out if your weight is healthy. The formula divides your weight in kilograms (kg) by the square of your height in meters (m2). While it's not a perfect measure of body fat or overall health, it provides a quick and easy screening tool for weight categories. (The CDC has an easy-to-use BMI calculator if you’re not sure what your number is or don’t want to bother converting from the metric system.)
Specifically, a BMI under 50 and a weight of under 350 pounds is necessary for nerve decompression surgery for diabetic neuropathy. To put this into perspective:
- A BMI of 18.5 to 24.9 is considered normal weight
- 25 to 29.9 is overweight
- 30 to 39.9 is obese
- 40 and above is severely obese
Severe obesity can complicate surgery and recovery. For example, administering and managing anesthesia can be more challenging in patients with very high BMIs. There's an increased risk of breathing problems, blood clots, wound healing problems, infections, and other complications during or after surgery.
If your BMI is over 50 or you weigh more than 350 pounds and you're hoping to undergo nerve decompression surgery, your health care team may recommend weight loss strategies to improve your surgical candidacy and overall health. For example, a medically supervised weight loss program can provide structured support, monitor blood sugar control, reduce pain, and enhance your overall quality of life.
Good Blood Flow in the Extremities
Your blood carries oxygen and nutrients that are necessary for tissue repair and fighting off potential infections. Good blood flow is also vital for the overall health of your nerves and surrounding tissues. This helps maintain nerve function and supports the regeneration process after nerve decompression surgery.
Dr. Williams will check for a palpable (detectable) pulse in your extremities. This simple test can indicate whether you have sufficient blood flow to support healing after surgery.
If there are concerns about your blood flow, he may recommend further vascular assessment. This could include an ankle-brachial index (ABI), which compares blood pressure in your ankle to that in your arm. An ABI of .85 indicates that you may be a good candidate for nerve decompression surgery.
If circulation issues are detected, your health care team may recommend treatments to improve blood flow before considering surgery. These could involve medications, lifestyle changes, or, in some cases, vascular procedures to increase blood flow to the leg.
Able to Tolerate Anesthesia
Your anesthesiologist will review your medical history, current medications, and any previous experiences with anesthesia.
While generally safe, anesthesia does carry some risks. These risks can increase if you have certain medical conditions. These could include:
- Severe heart or lung disease
- Uncontrolled high blood pressure
- Certain neurological conditions
- Sleep apnea
- Obesity (which ties back to the BMI considerations we discussed earlier)
No Open Wounds
One often overlooked factor that can make you a promising candidate for peripheral nerve surgery is the absence of open wounds on your feet or legs. Open wounds, particularly in diabetic patients, can be a sign of advanced neuropathy and poor circulation, which may complicate surgical procedures and healing.
A lack of open wounds indicates that you may be in an earlier stage of neuropathy, where nerve compression is more likely to be the primary issue rather than extensive nerve damage. If this is the case, addressing your nerve compressions before they lead to more severe complications often yields better outcomes.
Desire to Stop Relying on Pain Medications
Medications can temporarily muffle the symptoms of nerve pain, but they do not address the underlying issue that is causing your symptoms. If you have a nerve that is stuck, trapped, or compressed, clinical studies have shown that surgical treatment can lead to improved pain levels, improved sensation, and improved balance.
You can learn more about the results Dr. Williams has been able to achieve with his patients with compressed nerves in the setting of diabetic peripheral neuropathy—including how surgery reduced or eliminated the need for pain medication—by referring to the testimonials section of our website.
Age Considerations
While there's no strict cutoff for nerve decompression surgery for diabetic neuropathy, Dr. Williams typically prefers patients to be under 85 years old.
As we age, our body's ability to heal and recover from surgery starts to decline. People under 85 generally have better tissue repair capabilities, which is crucial for successful post-operative recovery. The immune system also weakens with age, potentially increasing the risk of post-surgical infections.
We know that the nerves of a 90-year-old do not heal as well as the nerves of a 20-year-old, so the results from decompression surgery may not justify the risks of surgery at this point.
Of course, it’s important to note that being over 85 doesn't automatically disqualify you from surgery. The age of 85 is more of a guideline than a strict rule and Dr. Williams will consider your unique situation. This includes factors such as:
- Your overall health
- Your physical fitness and activity level
- Your social support and ability to follow post-operative care recommendations
- The benefits of surgery versus the potential risks
Some patients over 85 may be excellent candidates for surgery if they're in good overall health and have a strong support system. Conversely, some younger patients might not be suitable candidates due to other health issues. Dr. Williams will be able to provide additional guidance after reviewing your medical records. (Learn how to prepare for your first visit with Dr. Williams.).