Year: 2022

Nerve pain is unrelenting and all too often, unbearable. When the time comes to take care of the problem at its source, who do you call?

just who is a nerve surgeon?

Simply put, nerve surgeons specialize in the surgical repair of peripheral nerves, but since nerves run throughout every inch of our bodies, there is not one specific type of surgeon or title that aligns precisely with the specialty of nerve surgery. Instead, there are several types of doctors who specialize in nerve repair. These doctors undergo extensive microsurgical training to become experts in their field.

While injured or damaged nerves can certainly cause a large amount of pain, they are very tiny structures and repairing them can require the use of magnification and specialized knowledge of nerve repair techniques.

The most common physicians who perform nerve surgery are:

• plastic reconstructive surgeons
• orthopedic hand surgeons

Additionally, there a select number of other specialists have undergone training for microsurgical nerve repair, such as:

• neurosurgeons
• oral maxillofacial surgeons
• doctors of podiatric medicine (DPMs)

Let’s dive in and learn a little bit more about these specialists, and how each—while not necessarily called a “nerve surgeon”—is qualified to treat nerve damage that may be the cause of chronic pain.

plastic reconstructive surgeons

You may be thinking, “Why would I go to a plastic surgeon for help with nerve pain?”

It’s a common misconception that plastic surgeons only perform cosmetic surgery. In fact, plastic surgery is generally broken down into two areas of concentration: cosmetic and reconstructive.

Cosmetic or aesthetic plastic surgeons often focus on breast augmentation, facelifts, rhinoplasty, etc.

Reconstructive plastic surgeons typically focus on more complex cases that may involve, for example, helping to save a patient’s limb after a traumatic injury or helping to rebuild an area of the face that has been badly damaged.

The word “reconstructive” means “to rebuild after something has been damaged or destroyed,” and these surgeons are trained to reconnect ligaments, muscle tissue and blood vessels to repair damage to a patient’s body. In addition, they often reconstruct and repair nerves.

With extensive microsurgical training, nerve repair is something that reconstructive plastic surgeons perform regularly, especially with patients facing chronic pain caused by a nerve injury.

orthopedic hand surgeons

You may think of an orthopedic surgeon as someone who you see when you break your arm or injure your knee, or when you need a hip replacement. That’s a fair assumption. Orthopedic surgeons specialize in treating your musculoskeletal system—your bones, joints, tendons, muscles and ligaments. They are experts at understanding where and how your body fits together.

And they can also specialize in nerve repair.

As doctors who specialize in muscles and nerves, many orthopedic hand surgeons have made nerve repair a primary focus. But don’t let the term “hand surgeon” fool you. The most common location for a nerve injury is the hand, and these surgeons have received extensive training on the intricacies of nerve repair, not just in the hand, but throughout the rest of the body.

neurosurgeons

While the term “neuro” and “nerve” may seem to go hand in hand, many neurosurgeons are mostly focused on the central nervous system (the brain and spinal cord), rather than the peripheral nervous system (the nerves running all through the body). The function of each is quite different and they serve different purposes.

There are some neurosurgeons who also specialize in working on the peripheral nervous system who are trained to deal with nerves throughout the body.

oral maxillofacial or Ear Nose and Throat (ENT) surgeons

Oral maxillofacial and ENT surgeons focus on the hard and soft tissues in the head, neck, face and jaw. These dental experts can help treat cleft lips, head trauma injuries, and perform reconstructive surgery on head and neck cancer patients.

Some oral maxillofacial and ENT surgeons are also skilled in performing nerve repair on injuries sustained to nerves in the face or jaw. For example, these specialists often work on nerve injuries that can sometimes occur during wisdom tooth extractions or other dental procedures.

foot and ankle surgeons, or doctors of podiatric medicine (DPMs)

It is important to recognize that most DPMs focus only on the tendons, bones and ligaments of the foot and ankle, and do not often specialize in nerve repair.

However, there are a small number of DPMs who have undergone microsurgical training to be able to perform nerve surgery in the feet and lower legs.

is there a qualified nerve specialist near me?

Take our quiz to see if you qualify as a candidate for surgical nerve repair. And then use our Find a Surgeon tool to see who might be a good fit for your needs and where they are located.

Not all plastic surgeons, orthopedic surgeons or neurosurgeons work with peripheral nerves. However, every doctor suggested through our Find a Surgeon tool—whether ortho, plastic or neuro—has taken specific interest in and developed a passion for helping patients with peripheral nerve injuries.

If you’re living with chronic pain, it may feel like opioids are the only way to find relief, however brief. Surgical nerve repair is a different approach.

For as long as we’ve been able to, humans have used opioids in some form or another to block pain. In the modern era, these include prescription pain relievers, heroin, and synthetic opioids such as fentanyl. While the intention is good—stopping the experience of pain—the side effects of opioids pose a large risk: addiction

The risk of addiction increases the more that opioids are used—especially when they are used to manage chronic pain over a long period of time. According to the Mayo Clinic, “Researchers have found that taking opioid medications for more than a few days increases your risk of long-term use, which increases your risk of addiction.”

According to the American Society of Anesthesiologists, “Opioids block pain messages sent from the body through the spinal cord to the brain.” When the pain relief wears off, addicted individuals can feel an urgency to find the next available relief and get another break from the constant pain.

Individuals experiencing chronic pain due to nerve damage could avoid prolonged use of pain relievers by considering a surgical option.

treating the source, not the symptoms

If you’ve been experiencing chronic pain after surgery, traumatic injury or amputation that lingers beyond the normal recovery time, it could indicate a nerve injury. Some studies have found that up to 77% of individuals have pain six or more months after experiencing trauma.

Unfortunately, the first course of action for patients with chronic pain is often to manage the symptoms through pain medications, which offer temporary relief but do not fix the source of the pain.

understanding your risk

Addiction is a disease that doesn’t discriminate. This means that anyone could be at risk of becoming addicted to pain killers—through no fault of their own. But individuals experiencing chronic pain have a higher risk than most of misusing their prescriptions with prolonged use. According to the National Institutes of Health, “With an increase in chronic pain, there has been a simultaneous rise in opioid use. This use has been associated with pain relief, but also with an increase in adverse outcomes (e.g., addiction, overdose, insufficient pain relief).”

Because of their addictive quality, it’s important to understand the risk when starting a prescription painkiller. By 2015, roughly 21%–29% of patients prescribed opioids for chronic pain misused them. And between 8%–12% of people using an opioid for chronic pain developed an opioid use disorder.

These numbers are staggering and emphasize how overwhelming the opioid crisis has become. But for those living with chronic pain due to a nerve injury, there is hope for another option. One that treats the source of the problem.

understanding pain

Pain is different for everyone. Some complain of tingling, numbness or pain all over. Others describe it as “pins and needles,” sharp spasms, a burning sensation, or extreme sensitivity to touch or heat and cold. It may be constant or intermittent.

When nerve damage causes nerve pain, it’s important to understand the options for repairing the source of the pain rather than typical treatments—like opioids—which may only temporarily manage the symptom.

As an alternative to prolonged use of opioids, surgical nerve repair focuses on identifying and repairing the cause of the pain, potentially providing a much more permanent solution.

patient spotlight: Achilles

On the brink of paid medication addiction, Achilles broke the cycle of pain and refills to find a better solution. Learn more.

repairing damaged nerves

Nerves can be injured in more ways than you might think. There are four common types of nerve injury that can sometimes lead to chronic pain:

• Cut or laceration
• Stretching
• Compression
• Neuroma

Nerves need a structure to help guide the regenerating fibers to grow properly. If a nerve is damaged, it may no longer have the proper structure to guide this growth, leading to pain. Depending on your specific nerve damage, your surgeon may be able to repair the nerve with a variety of different techniques.

Surgically repairing a damaged nerve can significantly improve a patient’s quality of life and even help them to live without pain entirely.

could surgical nerve repair help you?

If you’re facing chronic pain after a traumatic injury or a surgical procedure, answer these questions to determine if you’re a candidate, and get connected to a specialist who may be able to help.

When you’ve been dealing with ongoing pain, a visit to a peripheral nerve surgeon to determine if nerve damage is causing the pain and options for nerve repair surgery is an important step. It’s normal to have questions about the process. From your first visit to the post-surgery recovery, here’s a guide to everything you need to know.

considering nerve surgery

should I see a surgeon about surgical nerve repair?

If you’re experiencing pain persistent beyond a normal recovery time (3 months or more) after an injury (like a car accident, sports injury or glass or knife cut) or surgery (like an amputation, hip replacement, knee replacement or hernia repair), your pain could be due to a nerve injury. If it is, you may be a good candidate for surgical nerve repair and should see a surgeon. In one study, 70% of surgical nerve repair patients wished they would have been referred for surgery sooner.

In these cases, it’s important to see a nerve surgeon as soon as you can because the earlier you get surgery, the better your chances of restoring function and easing pain to the affected area.

If your symptoms are due to something other than a nerve injury, like diabetic neuropathy, nerve repair surgery is not likely to help.

what kind of questions will a peripheral nerve surgeon ask?

When you first visit a peripheral nerve surgeon, it’s helpful to be prepared for the questions they might ask. The more information you can provide the surgeon, the better they will be able to diagnose your issue and find a potential solution. It may help to write down answers to the following:

• How long have you been experiencing your symptoms?
• What body part or parts are affected?
• Did your symptoms begin after a specific event, injury, surgery (including an amputation or joint replacement) or accident (like a car accident or a serious cut)?
• What methods of controlling the pain have you tried (physical therapy, medication, etc.)?
• What medications are you taking, if any?
• What other specialists have you seen, if any?
• Have you had any other medical tests like an MRI, CT scan, nerve conduction study or X-ray?

what kind of tests will my surgeon have me do?

The types of tests ordered can vary based on your symptoms and the type of nerve damage suspected, but a nerve surgeon might ask you to undergo one or more of the following in addition to an in office exam:

• Ultrasound: A noninvasive test that uses sound waves to generate an image of the nerve.
• MRI/CT: Magnetic resonance imaging (MRI) and computer tomography (CT) exams provide a detailed view of the body in the area where nerve damage is suspected.
• Nerve Conduction Study: This is a study that tests your nerves with an electrical signal to pinpoint problems. Some patients report that it hurts a little, but most say it’s tolerable.
• EMG: An electromyogram (EMG) exam determines how well a motor nerve is working by measuring the electrical activity present in a muscle.

before the surgery

what questions should I ask before surgery?

• What kind of surgery am I having? It’s okay to ask for your surgeon to explain this multiple times to make sure you understand.
• When can I expect to notice improvement or relief after surgery?
• What outcomes can I expect?

how do I know what kind of nerve surgery I need?

Your surgeon will decide what kind of nerve repair may help you. The type of nerve repair will depend on your type of nerve damage.*

repair techniques based on type of nerve damage

• Cut: A cut nerve will require surgical nerve repair to bridge the gap between the two nerve ends and reconnect them, allowing the nerve to regenerate and restore the lost function.
• Compression: Cutting or removing the tissue restricting a compressed nerve allows the nerve to heal and restore normal signal transmission. After releasing the nerve, the surgeon may decide to protect the nerve by placing fat around it, wrapping the nerve with vein tissue or using a nerve protector.
• Stretch: A nerve can be damaged, even if it isn’t cut. The type of nerve repair performed for a stretched nerve will depend on the extent of the damage. This means using methods similar to repairing a nerve cut or a nerve compression.
• Neuroma: If a neuroma is identified as the cause of the pain, your surgeon will first locate and remove the neuroma to get rid of the painful stimulus and stop the pain signals to the brain. Then your surgeon can either repair the nerve by reconnecting it with a nerve graft (autograft or allograft) to allow restoration of normal signals to the brain, isolate the nerve end with a nerve cap to reduce the potential for symptomatic or painful neuroma formation, or in some instances reroute the nerve.

after the surgery

how long will I be in the hospital?

Your surgeon will work with you to determine your needs based on your specific case. However, many nerve repair procedures can be done on an outpatient basis.You may be asked to stay for observation for 24 hours, but in most cases, people are able to go home the same day.

when will I know if the nerve surgery was successful?

Some patients may get immediate relief—it depends on your nerve damage, and how long you’ve had it and how severe it was. However, if your nerve is reconstructed, return of sensation or nerve function takes time and can feel a little strange. You may feel some small zings and zaps as your nerve starts to heal, but that may be good news and a sign that your nerve is starting to work again.

You might notice the following sensations during the first six months after surgery, but they typically go away within 12 months:

• Hot or cold sensations and sensitivity
• Little shocks or zaps
• Aching or tingling feelings

If your pain persists or there is no return of nerve function, you should consult your surgeon.

how can i improve my chances of a positive outcome?

Be an advocate for yourself. Even if another doctor has told you that your chronic pain will get better on its own, or that physical therapy is your only option, you can still reach out to a nerve surgeon for a second opinion.

Do your research, and remember that nerves are delicate and deserve care.

You may want to bring another person, like a partner, family member or friend to any or all of your appointments. Your surgeon will be giving you a lot of information, and many patients find it helpful if another person has heard the same information and can help you remember.

is surgical nerve repair right for me?

*Source: https://www.axogeninc.com/patients/repair-options/

Nerves are like the electrical wires of the body, carrying signals to and from your brain. They allow you to move, feel and touch—but when one is cut or damaged, those signals are interrupted. This can cause pain, numbness, burning or loss of function in the affected body part.

nerve damage after surgery

Chronic post-operative pain is common. If you have pain after surgery that lingers beyond the normal recovery time, you may have a damaged nerve. Significant numbers (10%–40%) of patients experience chronic neuropathic pain after surgery. This is known as surgically induced neuropathic pain (SNPP).

Common signs of nerve damage include:

• Pain (especially tingling or burning sensations or sharp shooting pain)
• Numbness
• Pressure or squeezing sensation
• Weakness
• Hypersensitivity
• Physical changes (such as changes to muscle mass, skin color)
• Decreased motor function

Nerves can be challenging to see during surgery. Their size, anatomy and location can vary from person to person. Sometimes, a surgeon may unintentionally cut, compress or stretch a nerve. This damages the nerve and can lead to chronic pain.

what kinds of surgery can result in nerve damage?

Any surgery, routine or otherwise, can result in nerve damage, but it occurs most often in these types of procedures:

• Joint replacements such as hip or knee replacements
• Thoracotomy: a surgery where the surgeon cuts between the ribs to reach organs in the chest cavity (lungs, for example)
• Hernia repair: a procedure to contain the bulge of a hernia inside the body
• Caesarean section: also known as a C-section, this surgery ensures delivery of a baby through an incision in the birth mother’s abdomen
• Abdominoplasty: a cosmetic surgery to make the abdomen appear thinner and more firm, also known as a “tummy tuck”
• Hysterectomy: the surgical removal of the uterus
• Open reductions and internal fixation (ORIF): a surgery to repair broken bones that requires hardware to ensure the fractured pieces remain connected
• Nerve biopsy: a procedure to remove part of a nerve for sampling in a lab
• Amputation: loss or removal of a body part, such as a hand, leg, etc.
• Mastectomy: a surgical operation to remove one or both breasts
• Laparoscopic or arthroscopic procedures: also known as keyhole surgery, an operation that allows a surgeon to operate by inserting a camera into the abdomen, pelvis or knee through small incisions

what can i do about nerve damage after surgery?

A peripheral nerve surgeon may be able to help. Nerve surgeons specialize in the surgical repair of peripheral nerves, including nerve damage that may have occurred during a previous surgery. These include plastic reconstructive surgeons, orthopedic hand surgeons, neurosurgeons, oral maxillofacial (ear, nose and throat) surgeons, and foot and ankle surgeons (doctors of podiatric medicine). Learn more about the types of nerve surgeons and what they do.

If you’re ready to talk to a doctor about treating your chronic nerve pain, we’ve created a guide to help you locate someone.

nerve damage after hand injury: learn the signs

Hands are the most common site of a nerve injury. From everyday hazards like slicing into your hand with a kitchen knife, to more traumatic accidents like a run-in with a power tool or even a surgical injury, a hand injury can lead to chronic pain, numbness and more.

If you previously went to the ER for a hand injury, you may have a nerve injury without knowing it. As many as 91% of nerve injuries are missed in the ER, and these injuries may lead to chronic pain even after the original wound has healed.

which nerves are part of the hand?

There are three main nerves in the hand. All three branch out from the brachial plexus, the network of nerves that connects your spine to your shoulders, arms and hands. These nerves allow you to both move and touch with your hands.

• Median nerve: The nerve that runs from the shoulder down the front of the forearm to the hands.
• Ulnar nerve: The nerve that begins at the armpit and runs to the hand, responsible for controlling the small muscles of the hand.
• Radial nerve: The nerve that starts at the lower armpit, passing through the channel of bone and muscle at the elbow and extending to the wrist and hand. This nerve helps control the wrists, hands and fingers.

5 common causes of nerve damage from hand injuries

1. The most common cause of nerve damage involves cuts or lacerations to the nerve. This can happen while cutting into an avocado or bagel, slicing your hands on broken glass, or from broken bones, gunshot wounds or accidents involving power tools.
2. A previous hand surgery may also lead to chronic pain. A surgeon may have cut or otherwise injured a nerve, causing numbness, weakness, pain (tingling or burning) or other physical changes. If your symptoms remain past the expected recovery time, you may have a surgically induced nerve injury. Read how one patient, Benjamin, found healing after an arm surgery resulted in chronic pain.
3. Even a cut or wound that seems minor at first may lead to impaired hand function later. When nerves aren’t properly repaired after a surgical accident or other injury, they may form a neuroma, or a tangle of nerve tissue that can cause chronic pain.
4. Another common cause of nerve damage is compression. When too much pressure is placed on the nerve, it can become inflamed. A common example is carpal tunnel syndrome, which can occur from repeated grasping motions, such as at a computer desk or bicycle handlebars. Broken or fractured bones can also cause nerve compression injuries.
5. Stretching is another cause of nerve damage. This happens when the body moves suddenly in a way it doesn’t normally move, such as during a car accident or sports injury. In severe cases, injury to the brachial plexus—the network of nerves that connect your spinal cord to your shoulder, arm and hand—can lead to muscle weakness and pain in your hand. ­­

symptoms of nerve injury to the hand

Common symptoms of a nerve injury to the hand include:

• Pain in the hand—which can be excruciating, shooting pain that may feel like an electric shock
• Tingling, numbness or altered sensation
• Weakness or loss of motor function
• Loss of sensation, including either a full or partial loss of feeling
• Sensitivity to cold or heat
• Loss or decrease in hand function/fine motor skills, such as an inability to grasp things, frequently dropping things, difficulty tying your shoe or buttoning your shirt, etc.
• Inability to move the hand or wrist
• Decreased muscle tone in the hand

what can I do about nerve damage?

An orthopedic hand surgeon or plastic reconstructive surgeon may be able to help repair peripheral nerves by reconstructing the nerve (in the case of a cut) or freeing the nerve from the pressure of the surrounding tissue (in the case of compression injuries). The good news is that studies show positive improvements in quality of life for people who undergo surgery to repair a damaged nerve.

Timing is important when it comes to nerve repair. If you’re experiencing pain and/or numbness for more than six weeks after a hand injury or other previous surgery, you may have a nerve injury. The sooner you seek treatment, the more sensory and motor function you are likely to recover.

If you’re ready to talk to a doctor about treating your chronic nerve pain, we’ve created a guide to help you locate someone.

Nerves can be injured in more ways than you might think. From kitchen accidents, car wrecks, sports injuries to injury during surgery, there are several situations that can lead to damaged or injured nerves. But there are four common types of nerve injury that can sometimes lead to chronic pain:

• Cut or laceration
• Stretching
• Compression
• Neuroma

four common causes of nerve damage

When it comes to nerve damage, what causes nerve pain? And why? Let’s break down what each of these causes of nerve damage are, what they mean and how they commonly occur.

cut or laceration

The most common cause of nerve damage involves cuts or lacerations to the nerve. These injuries can occur due to a traumatic event or even during a surgery.

Individuals can sustain this type of injury if they have experienced a severe cut. For example, slicing into your hand while cutting an avocado or bagel or falling through glass. Nerves can accidentally be cut during surgery or may even need to be cut in a procedure like a mastectomy or tumor removal, where cutting the nerve may have been unavoidable. Nerves can also be cut by a broken bone.

stretching

Much like a rubber band, nerves have a tipping point when stretched too far. When that point is reached or exceeded, injury to the nerve can occur. Stretching can cause damage to the internal structure of the nerve, and the nerve may no longer function properly.

Nerves can be stretched too far during retraction of tissues during surgery, or, for example, during the placement or removal of orthopedic implants. In fact, 10%–40% of patients experience chronic neuropathic pain after surgery.

Nerves can also be stretched during an injury when sudden, sometimes violent, movement jostles the body in a direction it wasn’t made to move. When this fast, unnatural movement occurs, the stretched nerve fibers can be stressed to the point of injury.

A movement like this can occur in sports injuries, car accidents or even during childbirth. Depending on the extent of the injury, a stretched nerve injury may be temporary or permanent. If the damage to the nerve fibers is severe enough and the nerve is not fixed, the growing nerve fibers may form a painful neuroma which can be the cause of chronic pain.

compression

We all know what it’s like to be under a lot of pressure. When that pressure gets to be too much, we burn out, snap or give in. When nerves experience exceeding amounts of pressure, they also begin to perform at less than their best.

Nerve compression occurs when nerves are squeezed, pinched or otherwise pressured by surrounding tissues. This extra strain disrupts normal nerve function, which can lead to muscle weakness, numbness, burning or tingling, or immense pain.

Compression injuries often occur near joints like elbows, wrists and ankles—any place where surrounding bones, ligaments, tendons and muscles have an opportunity to add undue stress to the nerve. They can also be the result of a previous surgical or traumatic injury where scar tissue has developed and is compressing the nerve. When a nerve is compressed, it can become inflamed, which can lead to nerve pain.

neuroma

A neuroma is a tangled mass of nerve and scar tissue that may form when nerve damage, either from an injury or during a surgical procedure, goes unrecognized or isn’t properly repaired. Unrecognized nerve injuries are a common problem as often times nerve injuries are missed in the ER. When nerve fibers continue to grow without any structure to guide them, normal nerve function is disrupted and can lead to chronic pain.

Symptoms may include pain, loss of function, extreme sensitivity to touch or temperature, or in some cases numbness.

nerve damage and nerve pain

Any one of these common causes of nerve damage can lead to chronic nerve pain. When nerve damage causes nerve pain, it’s important to understand your options for repairing the source of the pain rather than typical treatments which may only temporarily manage the symptom.

Nerve repair is possible. Depending on your nerve injury, there are a number of surgical options available.