Why do I have a constant prickly-tingly feeling in my arm?

Courtney Pendleton, MD, a neurosurgeon who is fellowship trained in peripheral nerve disorders, explains what peripheral nerves are, problems that can arise with them and how they can be treated.

What are peripheral nerves?
I like to think of the nervous system as a large tree. The spinal cord is the trunk, and travels from your neck all the way down to your tail bone. Along the way it sends off branches – the major peripheral nerves. These nerves give off smaller and smaller branches and twigs that travel all the way down to the tips of your fingers and toes. These are minor peripheral nerves. All these branches and twigs – the peripheral nerves – do three things: they affect your motor skills (muscle strength, movement and power); your sensory skills (ability to feel); and they can trigger pain (usually a burning or “electrical” type of pain).

What problems can happen to them?
Peripheral nerve issues fall into three main categories: trauma, tumors and entrapment.

Trauma. Nerves can be injured in lots of different ways; they can be stretched, torn, bruised and cut. Sometimes, it’s possible to repair a nerve by sewing the cut ends back together. Sometimes the nerve can’t be repaired, but other nerves can be moved around to help give motor and sensory function back – these are what we call nerve transfers and nerve grafts. And sometimes, the nerve doesn’t need surgery! It just needs time to recover.

Tumors. People can develop tumors inside their nerves. The nerves are made up of a lot of little strands – about the size of a piece of thin spaghetti. To remove tumors inside the nerves, I move those strands away from the tumor, keeping that part of the nerve safe. Then I can take the tumor out. Most of these tumors are benign (non-cancerous). Very rarely, people can have malignant tumors – cancers – growing inside their nerves. These are complicated, and we have a large team at Stony Brook to make sure those individuals have the right care from start to finish.

Entrapments. As the nerves go from the spinal cord out to your arms, legs, fingers and toes, they pass through narrow spaces called “tunnels.” If those tunnels are really small, the nerves can get compressed and cause motor, sensory and pain problems like carpal tunnel syndrome of the wrist, which is the most common type. Entrapments can also happen at the elbow (your “funny bone” is actually a nerve entering a tunnel), knee and ankle. Minor surgery can open the tunnel.

Sometimes, people can get inflammation of the nerves. In those cases, I either take a biopsy of a skin nerve (only sensory), or take a small piece of a bigger nerve (motor and sensory) to get information so our medical team can make a diagnosis and develop a treatment plan.

How do I know if I have a peripheral nerve problem?
If you’re experiencing muscle weakness, loss of sensation that’s numb like ice or prickly like your foot being asleep, or burning/electrical pain – you might have an issue with a peripheral nerve. Sometimes problems in the brain or spine can cause similar symptoms. Sometimes problems with your joints (hips, knees, shoulders) can cause similar symptoms. Your primary care team can help decide what specialist is the best fit for your symptoms. I’m happy to see any patient with any peripheral nerve concerns. I’m also trained to perform brain and spine surgery.

Why Stony Brook?
As one of a handful of neurosurgeons nationwide with fellowship training in peripheral nerve surgery, I have developed a multidisciplinary Peripheral Nerve Surgery Center at Stony Brook. We have a team including neurosurgery, plastic surgery, orthopedic surgery and pain management that works together to create treatment plans for complex peripheral nerve problems including traumatic injuries, compression, tumors and painful lipomas, certain types of migraine headaches and painful neuromas that can occur after an amputation.

For an appointment with Dr. Pendleton, call (631) 444-1213. Learn more at neuro.stonybrookmedicine.edu