Challenging to treat, nerve injuries can impair patients’ sensation, reduce range of motion, and create chronic pain. The new Duke Nerve Center is designed to address cases ranging from simple carpal or cubital tunnel syndrome to complex cases involving injury to multiple nerves in the arms and legs as well as complications resulting from traumatic brain injury, spinal cord injury, and stroke. Led by peripheral nerve and orthopaedic hand and upper extremity surgeon Neill Y. Li, MD, the center provides multidisciplinary, coordinated care for both upper and lower motor neuron-related nerve injuries.

Treatment modalities at the Duke Nerve Center begin with a comprehensive evaluation with the surgical and rehabilitation team to determine avenues of conservative and surgical treatments. Physical and occupational therapists provide injury-specific programs to target the nerve injury, prehabilitate, and also provide custom bracing, splinting, and supportive maneuvers to ensure bones and soft tissues are well cared for during recovery.

The team uses nerve and imaging studies to determine the most accurate diagnosis. “We have worked closely with our radiology team to develop MRIs and ultrasound procedures dedicated to the study of nerves and localization areas for nerve injury,” Li says. “We seek to best determine whether a nerve is injured and to what degree to then whether the nerve will recover on its own. Depending upon timing from injury and recovery progression, we may discuss nerve procedures or tendon-, muscle-, and bone-related surgeries.”

The center offers nerve surgeries including reconstruction, transfer, decompression, and neurolysis. Depending upon the proposed nerve surgery, outcomes are commonly best within the first year from injury. If surgery fails or the critical period elapses, the team moves to tendon transfers to restore function. “Our goal is to provide patients with the full spectrum of treatment options from nerve to muscle, tendon, and bone,” says Li. “Our team is dedicated to staying with our patients from start to finish to ensure we maximize the potential toward recovery.” 

The center sees patients from infants to seniors. “It’s unique to have a single center for every aspect of peripheral nerve injury and regeneration basically from birth for patients with brachial plexus injuries to older adults facing strokes and traumatic brain conditions that occur later in life,” says David S. Ruch, MD, chief of hand surgery at Duke. “The neurologists, radiologists, surgeons, physical therapists, and occupational therapists are all a part of making that patient journey a success.” The comprehensive care across all the treatment modalities sets the center apart. “Not many places in the world have the kind of expertise in all of those arenas that Duke has,” says Ruch.

The center is committed to furthering the field with both education for physicians and dedicated research, including a basic science lab, the Peripheral Nerve Surgery and Regeneration Research Lab, with Li as a principal investigator. Hand surgeon Eliana B. Saltzman, MD, also contributes research on targeted muscle reinnervation noting unanswered questions in optimizing procedures and approaches to reducing pain in patients following amputation. 

The center will treat both upper and lower extremities impacted by:

• Brachial plexus injury: birth and adult
• Thoracic outlet syndrome
• Spinal cord injury
• Cervical radiculopathy
• Post-stroke recovery
• Spasticity
• Traumatic brain injury
• Parsonage-Turner syndrome/inflammatory neuropathy
• Peripheral nerve injury/palsy
• Nerve tumor
• Nerve entrapment/compressive neuropathy
• Amputation pain
• Neuroma pain

When a patient reports numbness, tingling, or loss of range of motion in a limb after an injury or surgery, nerve involvement would be suspected. Typically, peripheral nerve issues are unilateral. Bilateral symptoms usually indicate spinal or neurological involvement. For these and other spinal nerve injuries such as motor vehicle and motorcycle accidents, surgeon Deb A. Bhowmick, MD, serves as the center’s spine specialist.

Although nerve injuries are often not life threatening, they can significantly impact a patient’s quality of life. Patients should be referred to a center with a full array of diagnostic, rehabilitation, and surgical interventions if symptoms persist 8-12 weeks after onset.

Traditionally, providers may wait to see if a nerve injury heals independently, but this can delay crucial treatment beyond the optimal period for surgery. Li advises, “If you suspect a nerve injury and are considering advanced care, it’s best to refer early. Timely intervention can make all the difference.”