Spinal Cord, Nerve Root, Plexopathy

Nerve, nerve root and plexus disorders are some of the most common neurological diseases, sharing symptoms with such conditions as lower back pain. Mononeuropathy is damage to a single nerve or nerve group, polyneuropathy is damage that affects the peripheral nerves in approximately the same areas on both sides of the body and plexopathy affects the brachial or lumbosacral networks of nerves. 

The most commonly occurring forms of nerve, nerve root and plexus disorders vary widely in causes and symptoms:

• Carpal tunnel syndrome affects the wrist (the median nerve)
• Cubital tunnel syndrome affects the forearm (the ulnar nerve)
• Brachial plexus disorder affects the arms and hands
• Lumbosacral plexus disorder affects the posterior thigh, most of the lower leg and foot and part of the pelvis
• Transverse myelitis (inflammation) affects the areas below the point of the spine where the inflammation occurs
• Spinal muscular atrophy causes weakness and wasting of arm and leg muscles

Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition that causes numbness, tingling and weakness in your hand and wrist; it is caused by compression (pinched nerve) of the median nerve in your wrist. It may be caused by a number of conditions such as anatomical abnormalities (fracture, dislocation, smaller-than-normal carpal tunnel), chronic nerve-damaging conditions (diabetes), inflammatory conditions (arthritis), fluid retention, menopause, obesity, thyroid disorders, kidney failure and repetitive stress movements.

Women may be more susceptible to carpal tunnel syndrome because their carpal tunnels are smaller than those of men.

Diagnosis  of Carpal Tunnel Syndrome
Our team will diagnose your condition using several tests and procedures including a family and medical history, a physical exam (we will bend your hand at the wrist and tap on the median nerve), an X-ray, an electromyogram (tests muscle electrical impulses) and a nerve conduction study to exclude other possible causes. 

Treatment Options  for Carpal Tunnel Syndrome
If your symptoms are mild, we will suggest taking more breaks to rest your hands and applying cold packs to reduce the swelling. If your symptoms are more severe or do not respond to rest and ice, we will recommend wrist splinting, medications or surgery. 

Wrist splinting is generally done at night while you sleep to help alleviate symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen) can also help relieve pain and an injection of a corticosteroid (cortisone) can reduce inflammation and swelling and take pressure off the median nerve.

In carpal tunnel surgery, we cut the ligament pressing on the nerve to relieve pressure. During the healing process, this ligament grows back but still leaves more room in the carpal tunnel. This surgery can be performed open or endoscopically.

Cubital Tunnel Syndrome 
Cubital tunnel syndrome is similar to carpal tunnel syndrome except the nerve under pressure is the ulnar nerve. You may experience pain and numbness in your elbow and tingling in your ring and little finger.

A third similar syndrome, radial tunnel syndrome, occurs when pressure is exerted on the radial nerve which passes through the elbow. The pain occurs at the top of your forearm or back of your hand, often when you straighten out your wrist and fingers. Radial tunnel syndrome rarely causes numbness or tingling.

Diagnosis and treatment options for these conditions are similar to that for carpal tunnel syndrome.

Brachial Plexus Disorder 
The brachial plexus is the network of nerves that start in the cervical vertebrae (neck) and run down both sides of the upper spinal column located in the chest; the nerves control the arms and hands. Injury to the brachial plexus is the most common cause of this disorder, although conditions such as inflammation or tumors may also affect the brachial plexus. 

Symptoms may include shoulder pain and numbness or a burning and tingling sensation or weakness in your arm or hand. Serious injuries can tear or rupture the nerves and cause more severe symptoms; one of the most serious brachial plexus injuries, avulsion, happens when a nerve root is torn from the spinal cord.

In adults, injuries from sports and motorcycle accidents are the leading causes of this condition; however, complications at birth may cause this condition in infants. A breech presentation or prolonged labor may damage the brachial plexus; this is known as Erb’s palsy. Tumors may also place stress on the brachial plexus and a rare form of infection (brachial plexitis) can cause the condition without any physical injury.

Diagnosis  of Brachial Plexus Disorder
Our team will conduct a physical exam and ask for a medical and family history. We may want to perform a nerve conduction test to determine the speed impulses travel along the nerves, an electromyogram to measure the electrical activity in the muscles and an MRI scan to show us the extent of the damage to the brachial plexus.

We may also wish to perform a computerized tomography myelography in which we inject dye into your spine to produce a detailed cross-section of your spinal cord using X-rays.

Treatment Options  for Brachial Plexus Disorder
The treatment options available to you depend on the severity of the damage to the nerves. In cases where the nerves have only been stretched, rest and avoidance of the activity that caused the injury may be the only treatment you need. Physical therapy may help speed your recovery.

In the more severe forms of brachial plexus injury, you will most likely require surgery to reconstruct the elements of the plexus. Surgery is recommended within the first six months of the injury; after that period, your muscles may not be able to recover their function.

The three major types of surgery for this condition are nerve grafts, nerve transfer and muscle transfer.

Pain from a brachial plexus injury may be severe; we will help you manage it through the use of medications (codeine sulfate), antidepressants, anticonvulsants and muscle relaxants. We may also suggest using a transcutaneous electrical nerve stimulation device (TENS) that sends gentle electrical currents along the surface of your skin to help control pain.

Lumbosacral Plexus Disorder 
Lumbosacral plexus disorder is similar to brachial plexus disorder except damage to these nerves affects the legs. Diagnosis and treatment options are similar.

Transverse Myelitis 
Transverse myelitis is inflammation of the spinal cord, often specifically targeting the insulating material covering nerve cell fibers, the myelin sheath. It may cause injury across the spinal cord, affecting your ability to feel sensations below the point of injury. One or both sides of your body may be affected.

The symptoms typically develop over a few hours and get worse over a few days. Symptoms include sharp, shooting pains that start suddenly in your neck or back and radiate down your arms and legs and into your abdomen; sensations of numbness, tingling, coldness or burning that can cause the lightest touch to be painful; from weakness to paralysis in your arms and legs; and increased need or difficulty in urination, incontinence and constipation. 

Diagnosis  of Transverse Myelitis
Our team will diagnose your condition using several tests and procedures including a family and medical history, a physical exam and a clinical assessment of nerve function. We will use an MRI, lumbar puncture (spinal tap) and blood tests to determine spinal nerve inflammation.

Treatment Options  for Transverse Myelitis
We will provide treatments using intravenous steroids to reduce inflammation, plasmapheresis (plasma exchange ) to remove inflammation-causing antibodies, antiviral drugs in case we determine you may have a viral infection in your spinal column and pain relievers and antidepressants to help relieve pain.
 
In our focus on your long-term recovery and care, we will suggest physical and occupation therapy. It is difficult to predict the individual recovery trajectory from transverse myelitis; some people have little to no residual disabilities, while others experience relatively severe disabilities that may confine them to a wheelchair.

Spinal Muscular Atrophy 
Spinal muscular atrophy, a disease that often emerges in early childhood, is a genetic disorder that affects the control of muscle movement that is caused by loss of motor neurons in the spinal cord and the brainstem. This loss of neurons leads to weakness and atrophy of the muscles you use for walking, crawling, sitting up and controlling head movements. In severe cases, muscles used for breathing and swallowing can be affected.

Diagnosis  of Spinal Muscular Atrophy 
Our team will conduct a physical examination and family history, with some simple tests to rule out similar conditions such as muscular dystrophy.

We will recommend testing your blood for an enzyme called creatine kinase; this enzyme leaks out of muscles that are deteriorating. We may suggest genetic testing to establish you have the spinal muscular atrophy gene. We may want to perform a nerve conduction test to determine the speed impulses travel along the nerves and an electromyogram to measure the electrical activity in the muscles.

Treatment Options  for Spinal Muscular Atrophy 
No cure for spinal muscular atrophy exists at this time. Treatment   options involve helping you manage your condition, especially focusing on respiratory muscle weakness, swallowing muscle weakness and back muscle weakness. Our specialists will work with you to find a ventilation solution to supplement weak chest and ribcage muscles. For swallowing and chewing difficulties, we will help you work out a solution that may incorporate some soft foods orally and a feeding tube to make sure you are getting enough calories.

For back muscle weakness, our specialists will help devise a brace system to slow spinal curvature.