Peripheral nerve surgery encompasses acute nerve injuries, entrapment neuropathies and nerve sheath tumours. It is practiced by surgeons of varying backgrounds with expertise in orthopaedic, neurological, plastic and reconstructive surgery. Increasingly, several international centres of excellence have emerged whose surgeons are experts in the field and which offer the multidisciplinary care that patients with peripheral nerve disorders require. Most of these centres have websites outlining the services they offer but very few go into the level of detail which would clarify the concerns and queries that this group of patients commonly have.
www.neurosurgery.ucla.edu/Diagnoses/PeripheralNerve/
This is the website of the Division of Neurosurgery at the University of California in Los Angeles. The main diagnoses requiring surgical intervention are clearly listed from the beginning. Each is then elaborated in a question and answer type format clearly explaining anatomy, aetiology, treatment and prognosis. Links to relevant patient-information societies are given. The areas of their research are also briefly highlighted. The main drawback is the lack of diagrams and illustrations. However, in view of the clarity of explanations and layout, this site is probably the best starting point for the interested patient.***
www.neuro.jhmi.edu/Peripheral_Nerve/
This is a patient resource supplied by the Department of Neurosurgery at the Johns Hopkins University Hospital. Constructed on similar lines to the UCLA site, it gives a very basic introduction to the field of peripheral nerve surgery and most of the key headings are covered. The tumour section is still under construction. Although it is thin on details regarding what the patient is likely to experience with regards to investigation, treatment and recovery, it is again a fair starting point for any patient wanting to learn about the field.**
www.nlm.nih.gov/medlineplus/peripheralnervedisorders.html
This portal has been created by the US National Library of Medicine and the National Institutes of Health and contains a vast array of information specifically targeted to the lay person. It lists over 700 topics on various conditions with a medical dictionary available to the navigator. The medical encyclopaedia is well illustrated and with regards to peripheral nerves the links on brachial plexus injuries are the only ones covered in enough detail to be of any use to the patient.**
www.theuniversityhospital.com/healthlink/archives/articles/nerve.html
This link is from the site of the University of Medicine and Dentistry in New Jersey, USA. It is essentially a patient's account of his symptoms after developing a schwannoma (nerve sheath tumour) of his sciatic nerve. What is especially useful for patients and surgeons alike is the characteristic description given by this patient of the pain he experienced prior to surgery which is typical of neuropathic pain states associated with peripheral nerve disorders. The account later moves on to a general description by the operating surgeon on the principles of treating peripheral nerve trauma. Although just a single-page link, this is one of the very few patient accounts to be found on the net.**
www.wheelessonline.com
This constantly updated online textbook cannot be ignored in any website review of an orthopaedic-related specialty. It is widely accepted as a key resource for orthopaedic surgeons in training. The site has a whole section on nerves which can be easily navigated. The section is set out with a list of all the nerves in the upper and lower limbs and what follows for most of them is a description of the anatomy. Unfortunately, due to this layout, there is no real overview of the surgical disorders of peripheral nerves. Most sections have abundant links to abstracts on all the key topics in peripheral nerve surgery – an invaluable feature for the treating physician. The obstetric brachial plexus palsy (OBPP) section is poorly covered with no mention of Narakas' clinical classification of OBPP which is the key in determining the prognosis of these injuries. There are also very few diagrams or photographs. For those familiar with peripheral nerve surgery, the site acts as an excellent revision aid but fails to paint the whole picture.***
www.peripheralnerves.com
This site has been constructed by one of the previous registrars at our unit. It starts very promisingly giving a good outline of the work involved in the specialty and a very comprehensive review of obstetric brachial plexus palsy targeted both towards the patient and the surgeon. Unfortunately the remaining categories including adult trauma, tumours and nerve compression syndromes are all under construction. The site does not seem to have been updated for a while, but definitely holds a lot of promise.***
www.neurosurgery.com.au
With regard to design, this site created by three neurosurgeons in Melbourne, Australia, is extremely user-friendly and ideal for the patient. It follows a question and answer type format and what makes it unique are accompanying leaflets of postoperative instructions for the patients. However, as with other neurosurgical sites, peripheral nerve disorders are not well covered and this site only explains entrapment neuropathies of individual nerves and completely overlooks the brachial plexus and tumours.*