In rare cases, a nerve can get stuck transmitting pain. Maybe the nerve has been injured, or maybe a nearby structure is irritating it.
Neurosurgeon Dr. Christopher Winfree specializes in diagnosing and treating these and other types of nerve pain. To do so, he uses a full range of technology, from ultra high-tech devices all the way to the plain human hand.
On the high-tech end, Dr. Winfree has a few choices for making a diagnosis. He may order a high-resolution ultrasound, which uses sound waves to form pictures of a nerve. Or he might choose magnetic resonance neurography, which uses magnets and radio waves to look at the nerve and its function.
Guided by one of these scans, Dr. Winfree can even use a nerve block to “turn off” a nerve for a short time. Temporary pain relief after the block suggests that the nerve is contributing to the pain.
But one way he may begin to diagnose the cause of nerve pain is decidedly low-tech. All it takes is a firm tap with the fingertips. In an irritated or damaged nerve, a well-placed tap will often cause a somewhat painful tingling, or a feeling of “pins and needles,” further down the nerve.
This tingling is called a Tinel sign. It is named after Jules Tinel, a French neurologist who discovered it in injured WWI soldiers. Today, Tinel’s sign is often used to help diagnose carpal tunnel syndrome. But it is also useful in diagnosing other nerve pain syndromes.
Dr. Winfree spoke about Tinel’s sign during his talk at the most recent Congress of Neurological Surgeons meeting. His presentation focused on the diagnosis and treatment of nerve pain in the groin. Diagnosing nerve pain in this area can be challenging, since chronic groin pain has many possible causes. Several nerves exist in this area, but pain can also come from the spine, the hip or the pelvis. In some cases, no physical cause can be found at all.
If a doctor can determine for sure that the pain comes from a nerve, though, that nerve pain can often be treated. And a Tinel sign—which can be elicited quickly, cheaply and with no special equipment—is often the first step in making that diagnosis. Imaging and nerve blocks can then provide additional information to support (or refute) the diagnosis.
When it comes to treatment, however, nothing as low-tech as a tap is effective. Luckily, neurosurgeons today have lots of high-tech options. Depending on the case, they may surgically remove whatever is irritating the nerve, target the nerve with radiation or shut it down with chemicals.
Or they may implant a device that alters nerve function with small bursts of electrical activity, interrupting its transmission of pain.
But as Dr. Winfree pointed out in his talk, diagnosis doesn’t always have to be high-tech. With so many advances in medicine these days, sometimes surgeons need to be reminded of the value of their hands.
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