Peripheral Neuropathy

Peripheral nerve problems can involve changes in function, pain, and sensation due to previous surgeries, injuries, and, sometimes, systemic diseases.

UT Southwestern Medical Center surgeons are among a handful of specialists in the U.S. who are fellowship trained in evaluating and treating conditions that affect peripheral nerves.

What Is Peripheral Neuropathy?

This condition involves damage to the peripheral nerves, which span from head to toe, connecting the brain and spinal cord with the rest of the body. These nerves are critical for transmitting signals related to sensation, movement, and involuntary functions throughout the body.

Hundreds of disorders and injuries can affect the peripheral nervous system. Peripheral neuropathy can result from systemic diseases, previous surgeries, injuries, or exposure to toxins, leading to a wide range of symptoms.

What Causes Peripheral Neuropathy?

It can be caused by a variety of conditions that damage the nerves outside the brain and spinal cord. One of the most common is diabetes, particularly when blood sugar levels are not well-controlled.

Autoimmune diseases such as lupus, rheumatoid arthritis, and Guillain-Barré syndrome can also trigger peripheral neuropathy by causing the immune system to mistakenly attack the body's own nerves.

Other contributing factors include:

• Infections such as Lyme disease, shingles, and human immunodeficiency virus (HIV)
• Nutritional deficiencies, especially in vitamins B1, B6, B12, and E, as well as copper
• Exposure to toxins such as heavy metals and certain chemicals
• Excessive alcohol use
• Certain medications, such as some chemotherapy drugs
• Genetic conditions such as Charcot-Marie-Tooth disease
• Physical injuries
• Tumors pressing on nerves
• Vascular disorders affecting blood flow

What Are Common Symptoms of Peripheral Neuropathy?

Symptoms vary depending on whether sensory, motor, or autonomic nerves are affected.

Sensory nerve damage often leads to:

• Numbness, tingling, or a burning sensation in the hands and feet, which may spread upward into the arms and legs
• Heightened sensitivity to touch or pain from stimuli that are not usually painful

Damage to motor nerves can cause:

• Muscle weakness, cramps, or even paralysis, affecting coordination and mobility
• Difficulty walking
• Balance issues
• Difficulty performing tasks that require fine motor skills
• Muscle wasting or atrophy (from prolonged weakness)

Autonomic nerve damage affects involuntary bodily functions, leading to symptoms such as:

• Excessive or reduced sweating
• Digestive problems
• Abnormal blood pressure or heart rate
• Issues with bladder or bowel control

What Types of Peripheral Nerve Conditions Does UT Southwestern Treat?

Some of the peripheral nerve disorders our surgeons and care teams treat include:

• Brachial plexus injuries, damage to nerves controlling the shoulder, arm, and hand
• Carpal tunnel syndrome, nerve compression in the wrist
• Cubital tunnel syndrome, nerve compression in the elbow
• Facial paralysis
• Migraine headaches
• Nerve compression injuries of the leg and arm
• Nerve reconstruction
• Nerve-related pain (numbness, tingling, shooting pain)
• Peroneal neuropathy, nerve damage that causes foot drop and lower leg weakness
• Tarsal tunnel syndrome, nerve compression in the ankle

How Is Peripheral Neuropathy Diagnosed?

At UT Southwestern, patients receive a comprehensive evaluation to determine the extent and cause of the nerve damage. We begin with a detailed medical history and physical examination, focusing on:

• Symptoms
• Lifestyle factors
• Any underlying conditions, such as diabetes

We’ll perform neurological exams to assess reflexes, muscle strength, sensory perception, and coordination.

Based on the evaluation, the surgeon will decide whether additional specialists need to be involved and whether additional testing is needed, such as:

• Blood tests to detect vitamin deficiencies, metabolic disorders, or signs of autoimmune activity
• Imaging studies, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), to help identify structural issues or tumors
• Nerve function tests, including electromyography (EMG) and nerve conduction studies, to measure electrical activity in muscles and nerves to evaluate their function
• Nerve or skin biopsy to provide detailed information about nerve fiber health

How Is Peripheral Neuropathy Treated?

Because the clinical problems encountered in peripheral nerve damage can range from relatively simple to very complex, our surgeons work to develop a good rapport with each patient, which is important for obtaining optimal results.

Our treatments include:

• Therapies for facial paralysis
• Advanced minimally invasive nerve compression surgery for carpal tunnel syndrome and migraines
• Minimally invasive nerve release surgery in the leg and foot for patients with diabetes and other conditions
• Innovative microsurgical techniques to improve painful conditions involving the wrist, elbow, shoulder, chest, knee, and ankle, as well as to address pain after pelvic and inguinal hernia procedures
• Groundbreaking nerve reconstruction, such as nerve transfers and grafts to achieve better functional recovery over a shorter period of time
• Surgery to move or disconnect sensory nerves that cause pain
• Surgery to reconstruct nerves that have been severed as a result of trauma, tumor removal, or birth-related brachial palsy

If surgery is part of a patient’s treatment strategy, the surgeon will thoroughly explain what to expect during recovery and discuss whether physical therapy will be needed after surgery.