Centre for Nerve Surgery

Nerve-related conditions can be complex and require a comprehensive approach. The Centre for Nerve Surgery is operated by a multidisciplinary team dedicated to improving extremity form and function through effective patient-centred services. During each consultation, our team of specialists brings together their unique expertise and perspectives to develop tailored treatment plans that addresses the specific needs of each patient. Our team comprises of members from:

• Hand and Reconstructive Microsurgery
• Rehabilitation Medicine
• Neurology
• Hand Occupational Therapy

As a one-stop centre, we provide ready access to neurology, rehabilitation medicine, and hand occupational therapy, facilitating timely non-surgical management of a variety of nerve conditions. If there is minimal progress following conservative treatment or in the case of more severe nerve conditions, different types of surgeries can be considered:

• Nerve decompression a surgical procedure that relieves pressure by removing obstructions around a nerve.  This allows the nerve to recover its function and relieves pain caused by nerve compression.
• Nerve repair involves reattaching the damaged nerve ends to restore continuity and allow for nerve regeneration. This technique is typically used for injuries where the nerve ends are still in proximity.
• Nerve grafting involves taking a sensory nerve from another part of the body and using it to bridge the gap between the damaged nerve ends. This technique is used when the nerve ends are too far apart for direct end to end repair.
• Nerve transfer involves taking a healthy redundant donor nerve and rerouting it to a damaged recipient nerve necessary for a more critical function. This technique aims to restore some function by using an intact nerve to motorize the damaged muscles or provide sensation.
• Neurectomy involves cutting or removing a nerve to reduce muscle spasms and stiffness caused by spasticity. It is typically done when other treatments, such as medication or physical therapy, have not been successful in managing the spasticity.
• Tendon transfers involves using a tendon from a strong functioning muscle to power the tendon of a paralyzed muscle, thereby restoring critical motion, or enhancing strength in cases of paralysis.
• Free functioning muscle transfer employs microsurgical techniques to transfer a muscle along with its nerve and blood supply from one part of the body to another.  This approach is utilized to restore or improve muscle function in cases of severe muscle loss or paralysis. 

We specialise in the diagnosis and treatment of a wide range of nerve-related conditions, including:

Brachial Plexus Injury
Brachial plexus injury (BPI) is a condition that affects the network of nerves that control movement and sensation in the shoulder, arm, and hand. It commonly occurs because of trauma, such as during a motor vehicle accident or sports injury. Patients may experience pain in the upper limb, weakness or paralysis in the affected arm, and loss of sensation.  This injury can also occur in the process of childbirth.  When it comes to surgery for brachial plexus injuries, the specific operation chosen will depend on factors such as the time elapsed since injury, the location and severity of the injury, and the patient’s functional goals. Surgery to improve function in BPI often involves a combination of procedures such as nerve grafting, nerve transfers, tendon transfers, free functioning muscle transfer, and joint fusions.

Tetraplegia
Tetraplegia, also known as quadriplegia, is a condition that results in paralysis of all four limbs and the trunk due to a spinal cord injury. It typically occurs when there is damage to the cervical spinal cord, which is in the neck. Tetraplegia causes loss of sensation, muscle weakness, paralysis, and eventually joint contractures that limits the individual’s ability to move. Surgical treatment options for upper limb tetraplegia aim to restore function through tendon transfers, nerve transfers, and joint fusions.

Thoracic Outlet Syndrome 
Thoracic outlet syndrome (TOS) is a condition that occurs when there is compression of the nerves or blood vessels in the space between the collarbone and the first rib, known as the thoracic outlet. This compression can cause a variety of symptoms, including pain, tingling, numbness, and weakness in the shoulder, arm, and hand. It can be caused by factors such as poor posture, repetitive motions, or trauma. Treatment typically involves a combination of non-surgical measures using medications and physical therapy. In severe cases of TOS that do not respond to conservative treatments, surgical options such as decompression of the thoracic outlet are considered. 

Spasticity
Spasticity is a condition characterised by muscle stiffness, tightness, and involuntary muscle contractions. It is commonly seen in conditions such as cerebral palsy, stroke, traumatic brain injury, multiple sclerosis, and spinal cord injuries. It is caused by damage to the areas of the brain or spinal cord that control muscle movement. This damage disrupts the normal communication between the nerves and muscles, leading to increased muscle tone and stiffness. Spasticity can occur with dystonia that causes uncontrolled movements of the limb. Treatment for spasticity may include a combination of medications, physical therapy, assistive devices, and botulinum toxin (Botox) injections. Surgery for spasticity helps to improve limb posture and function by relieving muscle tightness through procedures such as neurectomy, tenotomy, or tendon transfers.