Stop Neglecting Your Peripheral Nerves with Dr. Catherine Curtin
On this episode of Scrubcast, host Rachel Baker speaks with Dr. Catherine Curtin, a professor specializing in plastic and reconstructive surgery at Stanford University's Department of Surgery. Dr. Curtin explains that peripheral nerves—nerves outside the brain and spinal cord—are the "neglected children" of medicine and can cause a wide range of problems from headaches to carpal tunnel syndrome. Her new favorite nerve is the peroneal nerve, which is located on the outside of the knee. She discusses common issues related to this nerve, including foot drop and clumsiness, while sharing insights from her research aimed at identifying individuals at higher risk of peripheral nerve injuries. The conversation also touches on the importance of preventative measures and advancements in diagnosing these conditions. Dr. Curtin discusses her research aimed at identifying at-risk individuals before they experience falls and injuries.
Don’t miss the episode's "lightning round" when Dr. Curtin shares her admiration for her mentor Dr. Rod Hentz, her mantra to "be the blessing," and her unique approach of letting awake patients choose the operating room music …and threatening Justin Bieber if they can't decide!
Links to International Orthopaedics articles:
An overview of common peroneal nerve dysfunction and systematic assessment of its relation to falls
Transcript
Rachel Baker: [00:00:00] Welcome to Scrubcast, where we take a closer look at the research happening at Stanford University's Department of Surgery. I'm your host, Rachel Baker. Today we're speaking with Dr. Catherine Curtin. Welcome to the show.
Catherine Curtin: Oh, thanks for having me.
Rachel Baker: I am so excited to have you here. Dr. Curtin is a professor in our Division of Plastic and Reconstructive Surgery, and you specialize in peripheral nerves.
Can you tell us what a peripheral nerve is and how one ends up specializing in their care?
Catherine Curtin: Yeah, so peripheral nerves, I think are the neglected children out there. These are the nerves that are outside of the spinal cord and the brain, and there are tons of them that give all kinds of troubles, and there really isn't a specialty that is dedicated to it.
People who are peripheral nerve surgeons or peripheral nerve experts kind of fall into it a little bit. [00:01:00] You can come into it from plastic surgery, you can come into it from neurosurgery, orthopedic surgery. There are just beginning to be specialty trainings. And so a lot of us just sort of found that there are patients who are having problem with their peripheral nerves and they can cause headaches, they can cause carpal tunnel, which is probably the one we know the most about, but they are in the lower extremity and after mastectomy, people have pain afterwards. I mean, anywhere outside the body that you have a nerve that would be a peripheral nerve. And peripheral nerve surgeons actually treat all of them.
Rachel Baker: Awesome. Well, so your recent research has focused on legs, specifically the peroneal nerve. Can you remind our listeners where that one is located?
Catherine Curtin: Yeah, so the peroneal nerve is my new favorite nerve. My favorite nerve changes probably on a weekly basis, but this one's been up there for a while.
So this nerve is on the [00:02:00] outside of the knee. Sometimes if you cross your legs for a long time and you find your leg maybe going to sleep a little bit, that might be where you're putting some pinching and pressure on the peroneal nerve. And so it is a commonly unhappy nerve for people. It causes foot drop.
So people who have foot drops sometimes have a peroneal nerve problem, but what we're realizing is it's actually unhappy a lot more than we have previously. Understood.
Rachel Baker: So a few years ago, my body had decided to trap my peroneal nerve with scar tissue, and I kept banging my toes getting out of the tub or tripping while I was walking my dog and people kept calling me clumsy and accident prone. And then I read your overview of common peroneal nerve dysfunction. It was published in International Orthopedics. I'll put a link in the description for our listeners. And I really felt validated because these [00:03:00] things that were happening are actually all related.
Catherine Curtin: Absolutely. I mean, that's where I, you know, was saying, I think we miss it a lot because of pure foot drop where you can't lift your foot, you know, everybody recognizes that. A little unhappiness of your peroneal nerve. You're catching your toe, you're clumsy. I mean, my sister actually has this, and we were walking on a trail and I was like, what is going on with you?
And she's tripping into like the walls and we looked and sure enough she had some weakness of her big toe lifting it up. And so as she was walking, getting a little tired, it was catching on the pebbles and the rocks and she kept tripping and because it's on the outside of the leg. It's just really at risk for all kinds of little traumas during the day that can get it all wound up.
Rachel Baker: So I assume chronic ankle instability is probably an outlier. How do normal people [00:04:00] injure their peroneal nerve? What kind of traumas are we thinking about?
Catherine Curtin: Yeah, so this is a little bit of emerging data. So number one is that I think that there are people who just have some swollen nerves, and there was just a study looking at the size of nerves in say, people with diabetes.
All of their nerves were a little bit more swollen. And so if nerves are a bit swollen, then when they go through a tunnel, they're at more risk for being pinched. Now the peroneal nerve, like I said, is on the outside of the knee, and so when you cross your legs, you are actually putting pressure on it.
Maybe you're leaning your knee against. The leg of a chair or something like that. So every day there's all these little things that are sort of tweaking it. And so if it's already a bit swollen for other reasons and then you add this on, then it can become pinched to the point where it doesn't work as well.
And that's where you get this little bit of [00:05:00] weakness in your toe.
Rachel Baker: Got it. Well, so there's a, a bit of a chicken and an egg problem here, right? Once someone falls or if your sister happens to be a. Peripheral nerve specialist and sees you tripping on rocks down the hike, you can check their peripheral nerve function, but we want to catch them obviously before they start tripping and falling and breaking their hips.
Can you tell us about the work you've been doing to identify people who might be at higher risk?
Catherine Curtin: Yeah, so that's my new passion with my new favorite nerve, but if we could identify this before you catch your toe on the wrinkle on the sidewalk, and you break your wrist or you break your face like that.
That's the goal. But how do you do that? So at first I thought, well, it's easy, you know, I know how to find this. I can do the exam, no problem. Everybody could do it. And, and that's when I realized, oh, actually these years of training have taught me things that are not so easily [00:06:00] transferrable in a five-minute thing.
So it made me realize that probably just examining people broadly is not going to work. So now we're working on other strategies. So the current work is, well, like I said, we know some people have a tendency to have some swollen nerves. And the swollen nerve that we most commonly are noticing is the median nerve and carpal tunnel.
So if people have carpal tunnel, maybe they also have this and they're just thinking they're clumsy.
Rachel Baker: Mm-hmm.
Catherine Curtin: So what we're working on is looking at if people with carpal tunnel also have this and our preliminary data suggests that this is a really good start. Pan surgeons who take care of carpal tunnel, they know how to do the nerve exam.
We don't have to teach them anything. And so they could look and say, Hey, you know, let's check this at the same time. And then maybe start on that preventative pathway.
Rachel Baker: What would the preventative pathway include?
Catherine Curtin: So first thing is you [00:07:00] stop crossing your legs, you know, and so I think there's some posture things.
It's not crossing your legs, making your nerve happy and seeing if that's enough. If that's not enough, there's some taping and some nerve glides, maybe conservative, but ultimately, if you're gonna have a risk of tripping and falling, I think that surgery to just release the nerve has to be lowered down on the treatment algorithm 'cause the impacts of falling can be so big. The surgery is just quite similar to a carpal tunnel syndrome, which many people have had, and it's a smaller procedure, which doesn't have a long rehabilitation, quite low risk.
Rachel Baker: Got it. Well, so I was reading your CV and one line stood out to me. What is the Robert Wood Johnson Clinical Scholars Fellowship?
I've never heard of this before.
Catherine Curtin: Really? Oh my gosh. [00:08:00] They would be so bummed to hear that.
Rachel Baker: I'm sorry.
Catherine Curtin: No, it's okay! So the Robert Wood Johnson Foundation has been sort of dedicated to improving health of all Americans, and so they have funded trainees. So I was a resident to be able to learn how to do research correctly.
Rachel Baker: Oh!
Catherine Curtin: And so as a resident, I went out and they taught you statistics and experimental design and helped you be able to be a good researcher.
Rachel Baker: So cool.
Well, that sound means that it is time for our lightning round. On each episode of Scrubcast, we ask each of our guests the same three questions.
And the first one is, who is a surgeon you admire and why?
Catherine Curtin: So I thought about this and I think Dr. Hentz, who was our senior hand surgeon here and my mentor. I think the why is because he is humble and was [00:09:00] always willing to help out. He still helps out at the VA. You could ask him to do a clinic. There was no task that was too small, and I really just, I appreciate that even though you're at the highest level, the president of the hand society, that you just wanna get things done and help everyone.
Rachel Baker: This is Rod Hentz. That's so cool. He is, I believe, speaking at our Holman Centennial in August about the history of plastic surgery, and I can't wait to hear his speech.
Catherine Curtin: He's a terrific person.
Rachel Baker: Cool. Well, the second question is what is the best advice you have received in 10 words or fewer?
Catherine Curtin: Yeah. This was a hard one, but I came up with, I think, something that I use now as a mantra in my mind, which is to “be the blessing.”
Rachel Baker: Okay.
Catherine Curtin: The idea that you are the one making things better and that you're not waiting for the blessing to happen to you, that you actually are gonna be the blessing. So I always try to think about that to be the [00:10:00] blessing.
Rachel Baker: I love that. Final question in the lightning round is, what is your preferred or music?
Catherine Curtin: So in our room, the patients are often awake. So I actually let the patient choose.
Rachel Baker: That's so cool.
Catherine Curtin: We have a wide variety. I still don't pay for Pandora, which is probably not good, but we have them pick, and we put it on Pandora. And so we've listened to a wide variety of things.
And if they can't decide, then I always tell 'em, well, if you let me choose, I'm gonna pick Justin Bieber. And then often that, um, that encourages them to pick their own music.
Rachel Baker: I didn't realize Justin Bieber was so divisive. Uh, well that concludes our lightning round and bringing us to the end of our show.
But before we go, I want to ask one final question, and that is what is next for Dr. Curtin?
Catherine Curtin: Yeah, so I am going to try and put in a grant [00:11:00] to see if we can really lock in. How is the best way to diagnose this? Is it gonna be technology, like a gait assessment? Maybe we could do on our iPhone? Is it going to be some physical exam findings that the hand surgeons can do, so that we can make this accessible to providers everywhere?
Rachel Baker: Fantastic. Well, I can't wait to see what you come up with and I'm crossing my fingers for you and that grant. Thank you so much for coming on the show.
Catherine Curtin: Thanks for having me.
Rachel Baker: And thank you to our listeners for tuning into this episode of Scrubcast. Until next time, stay sharp.
And that brings us to the end of another episode. If you like Scrubcast, we hope you'll tell your friends and subscribe wherever you get your podcasts. Scrubcast is a production of Stanford University's Department of Surgery. Today's episode was produced by Rachel Baker. The music is by Midnight Rounds, and our chair is Dr. Mary [00:12:00] Hawn.