Peripheral Nerve Injury & Restoration

BIDMC Center for Peripheral Nerve Injury & Restoration

Providing extraordinary, multidisciplinary care to patients with conditions affecting the peripheral nervous system, where the patient comes first, supported by world-class peripheral nerve education and research.

Patients being treated at the Center for Peripheral Nerve Disorders will benefit from a multidisciplinary and streamlined approach. Our team uses a collaborative approach that encompasses specialists from neurology, plastic surgery, orthopedics, neurosurgery, radiology, pathology, anesthesia and pain medicine, physical medicine and rehabilitation, and physical and occupational therapy.

As a team, we treat a wide spectrum of peripheral nerve conditions, including nerve entrapments, brachial plexus injuries, nerve tumors, traumatic nerve injuries, painful neuromas, migraines, failed nerve procedures and many more. The management of these conditions ranges from non-surgical treatment to surgical intervention. Conservative treatments include modalities such as physical and occupational therapy, ultrasound-guided injections and nerve hydrodissection, psychotherapy, pharmacotherapy and the use of spinal cord stimulators, among many others.

The surgical interventions we offer include (but are not limited to) nerve repair, release or nerve reconstruction, vascularized nerve grafting, nerve transfer, tendon transfer and free functional muscle transfer. As part of our surgical options, we routinely perform TMR (Targeted Muscle Reinnervation) and RPNI (Regenerative Peripheral Nerve Interface) for the management of neuroma-related pain. This includes phantom pain in the area of an upper- or lower-extremity amputation.

Diagnostics

The foundation of our program is a thorough in-person evaluation which begins with history-taking and physical examination. Depending on the initial findings, further testing with a nerve conduction study (NCS) or electromyography (EMG) is often required.

The peripheral nerve imaging service includes advanced magnetic resonance imaging (MRI) techniques, including brachial plexus, lumbosacral plexus and extremity neurography. These are performed using state-of-the-art magnets at BIDMC. We also offer advanced high resolution peripheral nerve ultrasound imaging. For select patients with superficial peripheral neuropathies, we offer novel ultra-high resolution ultrasound imaging with the Vevo system.

Research

Our program includes a robust translational research laboratory with the goal being to promote advances in the care of patients with peripheral nerve conditions. This spans from basic science and animal work through to human clinical trials, allowing therapies and diagnostics with a high potential to seamlessly and rapidly transition to patient care, minimizing any delay in their impact on patient outcomes.

Studies including quantitative EMG as well as imaging modalities such as high frequency ultrasound and MRI are currently being used at our center to correlate clinical and patient reported outcome measures with electrophysiologic parameters as well as cross-sectional imaging.

Education