Carpal tunnel syndrome results from compression of the median nerve in the wrist. Diagnosis requires electrophysiological testing. Initial treatment includes optimizing thyroid function and diabetes, avoiding strain to hand and arm, or cortisol injections. If conservative management fails, surgery will be offered to relax the tissues straddling the compressed nerve (carpal tunnel release surgery).
Palmar hyperhidrosis is excessive sweating in the hands that can be disabling. Endoscopic thoracic sympathectomy (ETS) aims at interrupting the sympathetic nerve connections to the sweat glands to keep the hands dry.
Peripheral nerve tumors cause pain, tingling, numbness or weakness in the affected limb. Sometimes a painful lump is found under the skin or in a muscle. Types of nerve tumors include neurofibroma and schwannoma. They are usually benign but invasive malignant peripheral nerve sheath tumors are encountered as well, requiring cancer treatments before or after surgery. Peripheral nerve tumors can usually be resected. Nerve monitoring including EMG and nerve conduction testing is used for safe surgery but sometimes the nerve must be sacrificed to remove all of the tumor, resulting in permanent loss of nerve function.
Trigeminal neuralgia is severe face pain that may not respond well to medication. Treatment options include partial destruction of the painful trigeminal nerve using radiosurgery, radiofrequency ablation (RFA) or chemical nerve destruction. If non-destructive treatment is favored, microvascular decompression surgery (MVD) offers protection of the trigeminal nerve from pulsating blood vessels.
Vestibular schwannoma, historically called acoustic neuroma, is a benign mass growing from the vestibular portion of the vestibulocochlear nerve (eighth cranial nerve, CN VIII). These tumors causes imbalance, nystagmus and hearing loss in the affected ear. The eighth cranial nerve runs close to the seventh cranial nerve (CN VII, facial nerve). Involvement of the facial nerve causes disfigurement, facial droop, inability to close the eye with damage of the cornea and blindness. Treatment for vestibular schwannoma is surgery through the posterior or middle fossa of the skull or radiosurgery (Gamma Knife, Cyber Knife etc).