A featured speaker at the WILG convention today was Dr. Tim Tollestrup, M.D., a Las Vegas physician who specializes in peripheral nerve surgery. Dr. Tollestrup had recently operated successfully on one of my clients with a crush injury to his foot, so I was interested in knowing more about him and his approach to treating difficult chronic pain cases. Dr. Tollestrup is one of only several surgeons in the country who focuses on eliminating chronic pain by applying accepted surgical techniques to peripheral nerve decompression or segmental denervation (cutting a peripheral nerve to interrupt the pain response.)
Peripheral nerves are all of the nerves in the body other than the spinal cord. Dr. Tollestrup explained that most physicians, including orthopedic surgeons, have very little training in the anatomy of the peripheral nerves. When patients have severe pain lasting longer than six months following an injury or surgery to a knee, shoulder, elbow, hand or foot, a compression, stretching, laceration, or crush-type njury to a peripheral nerve may be cause of the chronic pain. Surgery to treat the peripheral nerve injury may successfully eliminate the pain completely.
Dr. Tollestrup stated that it was very satisfying to be able to provide relief to a patient who may have had to take narcotic pain killers for months or even years. He also confirmed that it was very frustrating to chronic pain patients to be passed from one doctor to another after unsuccessful pain management.
X-rays, MRI’s, EMG and nerve conduction studies, are not very helpful in diagnosing a peripheral nerve injury according to Dr. Tollestrup, Instead, he depends on taking a careful history of the problem from the patient and on a hands-on clinical examination. Peripheral nerve surgery is a relatively new field, and additional research must be done before it can be applied to treat spine pain. tt was particularly exciting to learn about its success in treating complex regional pain syndrome and other types of chronic pain that have been baffling to physicians treating injured employees. Dr. Tollestrup’s website is NevadaNerveSurgery.org.