Angioma / fistula - private Beta Klinik Bonn

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Medical conditions peripheral nerves

peripheral nervesThe Beta Klinik treats different kinds of diseases of peripheral nerves. We focus especially on the following

Peripheral nerves diseases:

Furthermore, we employ state-of-the-art diagnostics to explore the origin of your peripheral nerves condition and to recommend you the corresponding therapy of peripheral nerves.

Morton´s neuroma / Morton´s metatarsalgia

Mortons´s neuroma, also called Morton´s metatarsalgia, is caused by an irritation or compression of toe nerves. Women are more frequently affected than men.

Symptoms Morton´s neuroma (Morton´s metatarsalgia)

Typical symptom of Morton´s neuroma is pain in the forefoot as well as in the third and fourth toe. Especially painful is wearing tight shoes. But there are no complaints when wearing wide shoes or walking barefooted. In the course of Morton´s neuroma, numbness of affected toes can occur. The symptoms of Morton´s neuroma in short:

  • pain in forefoot and toes no. 3 and 4
  • numbness of affected toes

Causes Morton´s neuroma (Morton´s metatarsalgia)

Morton´s neuroma is caused by an irritation or compression of toe nerves between the metatarsal heads of the second or third foot ray or at height of metatarsophalangeal joints. Permanent pressure brings about a node-like thickening (pseudo-neuroma) at the distribution of toe nerves. An additional compression can emerge through an inflammatorily changed and enlarged bursa, also located between metatarsal heads building a painful connection with the nerve node (ganglion). The disease is predominantly found between third and fourth, more rarely between second and third toe. Women are more likely to suffer from Morton´s neuroma than men.

Diagnostics Morton´s neuroma (Morton´s metatarsalgia)

Morton´s neuroma can be detected by emploing an MRI scanner. With the help of MRI, Morton´s neuroma can be visualized and differentiated from other diseases.

Given a correct diagnosis, Morton´s neuroma can be treated surgically with good results including improvement and being free of complaints.

Therapy Morton´s neuroma (Morton´s metatarsalgia) – neuroma surgery

Morton´s neuroma can be treated with microsurgery, so-called neuroma surgery. Drugs supporting the clotting of blood are to be stopped or substituted before neuroma surgery, if necessary after consulting the family doctor. Patients must have an empty stomach (this comprises eating, drinking and smoking). After the operation, it is not possible to drive the car by oneself but to let another person drive you.

During the out-patient neuroma surgery, regional anesthesia is applied plus optional sedation ('twighlight sleep'). A 3-4 cm (1-1.5 inches) long skin incision is performed at the bridge of the foot in height of the space between the third and fourth or the second and third toe. Given typical Morton´s neuroma, a thickened toe nerve is removed along with the enlarged bursa. Alternatively, a cut through a small ligament (ligamentum intermetatarsale) has to be considered, especially if no typical nerve change is diagnosed. At the end of neuroma surgery, a small drainage is placed into the wound, if necessary.

Aftercare neuroma surgery

To avoid a swelling after the surgical treatment of Morton´s neuroma and to support quick recovery, the feet has to be put up consequently within first postoperative days and must not be strained. Despite these requirements, movement of the ankle for the activation of calf muscles is necessary in order to prevent thrombosis. Bandages are changed and the drainage removed on first day after neuroma surgery by Beta Klinik´s doctors or a family doctor. After 7-10 days, stitches are removed. A day later, washing the foot is possible again. Slowly, the foot can be increasingly strained from now on, although it might be painful within first weeks or longer.

Complications (general/special) neuroma surgery

Small hematoma and swelling disappear spontaneously after the surgical removal of Morton´s neuroma. Additionally to loosening bandages, ice packs have to be applied several times a day in case of sever swellings. But the wound has to be kept dry and must not get wet.

The inflammation or infection rate of patients after neuroma surgery is very low. Given any signs of infections like pounding pain in surgical area, reddening or festering of the wound, a doctor must be consulted immediately. The best is the prompt consultation at Beta Klinik.

A feeling of numbness of exists before surgery due to Morton´s neuroma. Apart from that, numbness can also emerge after neuroma surgery but without having disturbing impacts.

For 20% of patients, the surgical treatment of Morton´s neuroma does not result in a satisfying relief or improvement.

Caution!

If unexpected symptoms occur after neuroma surgery, for example, severe pain, movement limitations of joints or a severe swelling, please consult Beta Klinik.

Carpal tunnel syndrome

The carpal tunnel syndome is caused by a compression (clamping) of the median nerve in the wrist canal (carpal tunnel). Carpal tunnel syndrome emerges in middle and higher age, and more frequently women are affected. But the carpal tunnel syndrome is also to develop earlier, for example, during pregnancy.

Symptoms carpal tunnel syndrome

A typical symptom of the carpal tunnel syndrome is the nightly falling asleep of one or both hands, also called paresthesia. Progressive symptoms of carpal tunnel syndrome are the permanent sensation disturbance in finger 1 to 3 and later thenar muscle atrophy. Here are the symptoms of the carpal tunnel syndrome in an overview:

  • one or both hands fall asleep (paresthesia)
  • sensation disturbance in finger 1 to 3
  • thenar muscle atrophy

Causes carpal tunnel syndrome

The carpal tunnel syndrome is likely to be hereditary, but it is also caused by a multitude of factors, for example, chronic thickening of tendon sheaths or hormonal changes.

Diagnostics carpal tunnel syndrome

The Carpal tunnel syndrome is normally diagnosed by measuring the electrical conductivity of the nerves. The surgical therapy of the carpal tunnel syndrome in time makes a permanent cure possible. The disease has to be differentiated from a disc herniation in cervical spine.

Therapy carpal tunnel syndrome – carpal tunnel surgery

The carpal tunnel syndrome can be treated by microsurgery, a so-called carpal tunnel surgery. Drugs supporting the clotting of blood are to be stopped or substituted before surgery, if necessary after consulting the family doctor. Patients must have an empty stomach (this comprises eating, drinking and smoking). After surgery it is not possible to drive the car by oneself but to let another person drive you.

Carpal tunnel surgery can be done as an out-patient using regional anesthesia plus optional sedation ('twighlight sleep'). Aim of the operation is to relief the median nerve by opening the wrist canal (carpal tunnel). During this procedure, a soft-tissue-like ligament (retinaculum flexorum) is cut through.

Complications (general/special) carpal tunnel surgery

After the surgical treatment of the carpal tunnel syndrome, small hematoma and swellings decrease quite quickly through active finger gymnastics and loosening of bandages. In case of severe swellings, several ice packs are to be applied in addition to loosening of bandages. But the wound has to be kept dry and must not get wet. In rare cases, a temporary worsening of nerve functions can occur after carpal tunnel surgery.

The inflammation or infection rate after the surgical therapy of the carpal tunnel syndrome is very low. Given signs of infection like pounding pain in the surgical area, reddening or festering of the wound, a doctor has to be consulted immediately. The best is to come to Beta Klinik instantly.

Theoretically, a damage of the median nerve during surgery is possible but has never occured in our practice. Extremely rare is the emergence of a sympathetic reflex dystrophy, also called complex regional pain syndrome (CRPS).

A slow or missing recovery of the nerve is often due to a too late surgery. If the carpal tunnel syndrome has caused sensation disturbances a long time before surgery, sensation disturbances can also need a long time up to month to go away.

A new clamping of the nerve, a so-called recurrent carpal tunnel syndrome, is very rare.

Aftercare carpal tunnel surgery

After carpal tunnel surgery, a few things have to be considered. To avoid a swelling of the hand and to recover quickly, the hand has to be positioned at chest height and strains are to to be refrained from. A sling is not necessary. From surgery date, an active gymnastics of the affected hand is required. Patients have to clench their fists but also stretch their fingers completely several times an hour.

On first day after carpal tunnel surgery, the bandages are changed by the attending or the family doctor. Given surgery on Friday, cange of bandages is done the next day by the patient and his relatives, at least on Monday by the family doctor. Slowly, the hand can be increasingly strained. After 7-10 days, stitches are removed and washing hands and showering is possible without protective gloves. The hand can be regularly used for daily and most occupational activities after 2-3 weeks. A certain feeling of pain in the palm of the hand – the younger the patients the more often – has to be accepted. The complaints normally vanish almost completely after weeks and are not subject to the surgical procedure.

Caution!

If unexpected and unusual symptoms occur after carpal tunnel surgery, for exapmle, severe pain, mobility limitations of joints or severe swellings, please visit Beta Klinik immediately.

Cubital tunnel syndrome / ulnar nerve entrapment

The cubital tunnel syndrome, also called ulnar nerve entrapment, is caused by a compression of the ulnar nerve in the cubital tunnel, a canal proceeding through the elbow.

Symptoms cubital tunnel syndrome (ulnar nerve entrapment)

A typical symptom of the cubital tunnel syndrome is sensation disturbance or numbness of the little finger, the side of the ring finger showing to the little finger and the side of the hand next to the little finger. A longer ulnar nerve entrapment is to cause a loss of strength or paralyzation of the hand, for example, while writing, opening a bottle or a can and spreading of fingers. At a progressive state, a severe symptom of cubital tunnel syndrome is atrophy of the middle hand, best visible between thumb and index finger. Irradiating pain from the inner side of the elbow into the little finger is quite rare. Here are the symptoms of cubital tunnel syndrome in an overview:

  • sensation disturbance / numbness of little finger, the side showing to the little finger of the ring finger and the side of the hand next to the little finger
  • loss of strength or paralyzation of the hand
  • atrophy of the middle hand
  • rarely pain radiating from the inner side of the elbow into the little finger

Causes cubital tunnel syndrome (ulnar nerve entrapment)

Cubital tunnel syndrome can have several causes: elbow damage dated back several years, arthrosis of the elbow or chronic pressure damage of the nerve. The latter often originates from supporting elbows on a hard underground, for example, a desk, or from long lasting bending of elbows, for example, at night.

Diagnostics cubital tunnel syndrome (ulnar nerve entrapment)

The diagnosis cubital tunnel syndrome is confirmed by measuring the electrical conductivity of the nerves. A therapy in time can provide a permanent cure. But existing atrophy caused by cubital tunnel syndrome may not or not sufficiently decrease.

Therapy cubital tunnel syndrome (ulnar nerve entrapment) – cubital tunnel surgery

The cubital tunnel syndrome can be treated by microsurgery, a so-called cubital tunnel surgery. Drugs supporting the clotting of blood are to be stopped or substituted before cubital tunnel surgery, if necessary after consulting the family doctor. Patients must have an empty stomach (this comprises eating, drinking and smoking). After the operation, it is not possible to drive the car by oneself but to let another person drive you.

During the out-patient cubital tunnel surgery, regional anesthesia is applied plus optional sedation ('twighlight sleep'). The first step of surgical exposure and relief of the entrapped ulnar nerve is a skin incision of 3-4 cm (1-1.5 inches) at the inner side of the elbow. A soft tissue over the nerve and, if necessary, a muscle (m. epitrochleoanconaeus) is cut through to remove the ulnar nerve compression. Under certain circumstances, the ulnar nerve is relocated at the front side of the elbow. A small drainage is placed into the wound at the end of cubital tunnel surgery.

Complications (general/special) cubital tunnel surgery

After the surgical solution of the cubital tunnel syndrome, small hematoma and swellings best decrease through aktive movement and loosening of bandages. A severe swelling necessitates additional ice pack treatments. But the wound has to be kept dry and must not get wet.

The inflammation or infection rate of patients undergoing cubital tunnel surgery is very low. In case of any sign of infection, for example, swelling, pounding pain in the surgical area, reddening or festering of the wound, a physician has to be consulted. The best would be a consultation at Beta Klinik.

Theoretically, a damage of the ulnar nerve is possible. Extremely rare is the emergence of a sympathetic reflex dystrophy, also called complex regional pain syndrome (CRPS).

Ulnar nerve recovery takes quite long because of the long recovery line from the elbow to the fingers. Thus, the decrease of sensation disturbance and loss of strength (paresis) can take a long time. In case cubital tunnel syndrome has caused atrophy, the improvement is often incomplete.

A new compression of the ulnar nerve (so-called recurrent cubital tunnel syndrome / ulnar nerve entrapment) is rare, especially when pressure to the elbow near at and around the operated area is avoided.

Aftercare cubital tunnel surgery

To avoid a swelling of the hand and to recover quickly, the hand has to be positioned at height of the upper body, and strains are to to be refrained from. A sling is not necessary. From first postoperative day, a careful movement of the elbow is necessary.

The fist change of bandages takes place on the first day as well as the removal of the drainage. Slowly, hand and arm can be increasingly strained. Stitches are removed after 7-10 days. Washing the arm and showering are possible at the following day. The arm needs 2-3 weeks of low strain to be used for normal daily activities and most occupational ones. To take care of the ulnar nerve, a strong bending of the elbow over a long period, for example, while supporting the arm on the desk or while sleeping, should be avoided from now on.

Caution!

If unexpected symptoms after cubital tunnel surgery occur like severe pain, movement limitations of joints or a severe swelling, please consult Beta Klinik.

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Dear visitor,

Beta Klinik extends from the Head and Spine Center to the International Private Clinic with many specialists, providing you with an excellent medical and personal care across all medical disciplines. Therefore, we want to inform you about our new range of medical departments. We will re-design and update our website accordingly within the next 1-2 months.

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