how can surgery result in nerve damage?

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

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.

what causes numbness and tingling in arms and hands?

You may be familiar with the numbness or “pins and needles” feeling from staying seated in one position too long, or from holding your arm at an uncomfortable angle for a period of time. But when this numbness or tingling does not go away quickly, or has no obvious cause, it may be a sign of nerve damage or other medical problems.

causes of numbness

Many cases of numbness and tingling in the arms and hands are a result of a nerve injury or accident. These injuries may make you a candidate for surgical nerve repair to relieve the numbness, pain or other symptoms that affect your quality of life. These injuries could be due to:

  • Traumatic event or accident
  • Prior surgery
  • Prior injury from a fractured or broken bone
  • Long-term compression (often due to overuse)

what types of nerve injuries could cause numbness and tingling?

There are seven nerves that control sensation to the hands and arms:

  • Axillary nerve injury can cause numbness and weakness in the outer shoulder. This could be due to improper use of crutches or cast placement, a traumatic injury or event (like a car accident), a bone fracture of the upper humerus, a dislocated shoulder, or prior shoulder arthoscropy (surgery to repair joint problems).
  • Brachial plexus nerve injury can cause a limp arm, pain and numbness in the shoulder. This could be due to a traumatic accident or injury, or Erb’s palsy (which can occur during childbirth, or due to an accident later in life).
  • Musculocutaneous nerve injury can cause pain, tingling or numbness of the outside of the forearm. It can happen due to overusing the biceps, a traumatic injury to the shoulder or arm or surgical injury (usually during surgery on the humerus bone).
  • Median nerve injury can cause numbness, pain, tingling or weakness of the forearm, wrist or hand. This could be due to a traumatic injury or entrapment of the nerve near the wrist. This entrapment is called carpal tunnel syndrome and is common among people who use repetitive wrist or hand motions.
  • Ulnar nerve injury can cause numbness, pain, tingling or weakness in the hand, inability to move your fingers, and weakness when flexing the hand. Common causes include entrapment of the nerve around the elbow or the palm, an injury such as a glass cut or car accident, or long-term compression (such as from bicycle handlebars or using a computer mouse for long hours).
  • Radial nerve injury can cause numbness, tingling or weakness in the wrist, fingers and thumb. This can happen due to entrapment of the nerve (carpal tunnel syndrome), traumatic injury or accident (such as from power tools or a car accident), or breaks in the humerus bone.
  • Digital nerve injury can cause numbness, tingling or pain in the fingers. Causes include a cut or laceration to the fingers, or a traumatic injury.

other causes of numbness

Not all cases of numbness and tingling are a result of nerve damage. Chronic loss of sensation in the arms and hands is also called peripheral neuropathy, and its cause could be a wide range of medical conditions. Peripheral neuropathy is different than a nerve injury, and it cannot be fixed with surgical nerve repair.

how can i regain feeling in my hands and arms?

Most people experience numb or tingling hands and arms from time to time. But when it affects your quality of life, it’s time to seek help. If you suspect your symptoms are caused by nerve damage, we’ve created a guide to help you locate a doctor who treats nerve problems.

how to talk to your doctor about pain

“What brings you in today?”

The pause before answering that question is not uncommon, and it’s rarely easy to answer.

How do we talk when we talk about pain? And how do we talk to others about our pain? More so—how do we talk to our doctors about pain? Making sure that our doctors take our pain seriously is critical as we look to them for guidance on how to improve our pain or eliminate its source.

Is there specific pain terminology we should be using? A secret language about pain that makes it easier to relate? Or are our senses and memories easier to reference when trying to convey the distinct and direct pangs experienced during bouts of chronic pain?

These are the questions that keep us up at night.

Thankfully, there are many pain assessment tools that exist to help patients and doctors talk about experiencing and managing pain. Understanding the common phrases and practices used to quantify and qualify pain will make sure you’re prepared to talk about it when appointment time comes.

the pain scale

Pain is inherently subjective, so finding a common ground for discussing its impact is crucial. There are several different pain scales that your doctor may use. The Numeric Rating Scale (NRS-11) was invented by Dr. Ronald Melzack and Dr. Warren Torgerson of McGill University. Derived from the McGill Pain Questionnaire, the NRS-11 is an 11-point scale for patient self-reporting of pain. These 11 points on a spectrum range from zero to 10, with zero denoting no pain and 10 denoting the worst pain imaginable. All points are based on the ability for persons 10 years or older to perform daily activities.

This scale lets doctors and patients speak about pain in a common, simplified language. “On a scale of one to 10, how much does it hurt?” This question becomes much easier to answer and creates a solid starting point for continued conversation about managing and alleviating pain.

 

For children, there’s the addition of the Wong-Baker FACES® Pain Rating Scale, which adds a visual element to the pain scale and allows children to align their feelings to an expressive face.

Of course, qualifying that pain becomes even more important once you’ve established its quantitative level.

common pain terminology

Is it a sharp pain or a dull pain? Is it burning or tingling? After establishing the level of pain, being able to articulate the kind of pain may help narrow down treatment options or solutions.

Here’s a list of common terms used when talking about pain:

  • aching
  • biting
  • burning
  • cramping
  • draining
  • dull
  • exhausting
  • gnawing
  • heavy
  • hot
  • piercing
  • pinching

 

  • pressure
  • sharp
  • shooting
  • sickening
  • sore
  • splitting
  • stabbing
  • tender
  • throbbing
  • tingling
  • tiring
  • twisting

 

With the above words as tools you can more easily describe your situation. For example, “It feels sharp and stabbing. It’s like a lightning bolt that pierces quickly without warning.” Or even, “My arm is constantly aching and tender to the touch. It feels like pins and needles that don’t quit.”

Sentences like these provide more context as to the duration of the pain, the sensation and the degree to which the feeling persists. When describing how you feel, make sure you’re also able to communicate:

  • How long you’ve had the pain
  • Where the pain is located
  • When the pain is present—is it constant, or does it come and go?
  • What activities aggravate the pain, trigger the pain, or soothe the pain

medical pain terminology

To get even more detailed, you can move beyond the common terms and use more clinical pain terms. Combining a common language of pain with medical terminology will set you up for a successful conversation during appointments. For example, there is more than one type of pain, medically speaking:

  • Acute: a sudden onset of pain that usually lasts for a short period of time
  • Chronic: a condition that lasts for a long time, it can be constant or intermittent
  • Visceral: pain related to the internal organs in the midline of the body
  • Somatic: pain that occurs in tissues such as the muscles, skin or joints
  • Myofascial: pain and soreness in the muscles
  • Breakthrough: pain that occurs suddenly or as a result of a specific activity
  • Inflammation: a reaction of tissues to injury or disease; commonly manifests as swelling, redness, heat and pain

There are plenty of other terms used in the universe of pain management. Many are documented in pain management glossaries and online reference materials.

advocating for yourself

Armed with the right tools to talk about pain, you’ll be better equipped to communicate what you are feeling and how it impacts your day-to-day life. Bring in notes and write out any questions you may have ahead of time so you’re ready to ask, listen, and make a plan to move forward toward a pain-free solution.

navigating nerve pain

When you’re ready to talk to a doctor about pain, we may be able to help. If your chronic pain started after a traumatic injury, surgery, or amputation, it could be the result of nerve damage. Take the quiz to see if you’re a potential candidate for surgical nerve repair.

surgical nerve repair gives Chris relief from post-amputation pain

Chris lives in Southern Georgia with his wife and their four children. He works at a pulp mill where he oversees some of the factory’s key equipment.

One day, calamity struck and changed Chris’ life forever.

accident leads to lost arm

“I went into work one day and we were having problems with one of the machines. I wasn’t even actually supposed to be there that day. I went to see if I could help. And in the process of doing that, I got my hand caught in the machine and it ripped my arm off.”

His coworker rushed to his aid, using his own belt as a tourniquet and the shirt off his back to apply pressure before Chris was picked up by ambulance. The paramedics, after seeing the damage that occurred, opted to call in for a helicopter to airlift him to a hospital.

Chris had four surgeries in 10 days. “I stayed in the hospital for about two weeks and they were not able to save my arm from the accident. Once I got home from the hospital, I began experiencing excruciating pain. It was rough going day-to-day, I would cry myself to sleep. If I could sleep.”

“There were times too where you didn’t know what your life was gonna be like going forward, because you couldn’t live in that state. Nobody could live in that state. I mean, it was that bad,” said Chris. “I wanted to spend that time with my family, but I was literally unable to do that just from the pain.”

real pain, phantom limb

“I went to pain management to help alleviate the pain and it initially helped. And it helped throughout the process, but the pain was always there. It would seem to never go away.”

Chris often felt like “a bolt of lightning was starting from the top of my arm and shooting down the rest to my arm—an arm I didn’t have. It’s crazy to imagine, I lost my arm in an accident, but I could still feel the entire arm like it was there.”

“Other times, it would feel like the arm was on fire, it was burning. And then there were other times where my ‘arm’ felt under a lot of pressure, like my arm was getting crushed.”

The pain Chris experienced is unfortunately not uncommon after an amputation. Phantom limb pain is experienced by 50-85% of people with an amputation.  For Chris, it seemed that the only option presented to treat the pain was prescription medication, and it would help, but then other side effects would come with it. “I would not want to get out of bed. I couldn’t get out of bed,” said Chris.

“I was actually terrified to be on pain medication because I know what drugs do to people. People get hooked onto them and it ruins lives and I didn’t want that for me. I didn’t want that for my family. I wanted to overcome that. Really, the only other solution that we had was to maybe kill those nerves. And I didn’t want to do that either, because if I’d done that then I’d have lost all function in my shoulder.”

Chris was determined not to rely on pain medication for the rest of his life. And in his search for help to wean off medication, he came across Dr. Kolovich who offered a different approach.

repairing nerves to remove pain

“When Chris came in, he was on high-dose narcotics. He was restless. He had bags under his eyes. He was flushed. He was sweating. He was pacing around my room. He just had all the classic signs of neuropathic pain and that’s pretty common after a traumatic injury. He was clearly just trying to get his life back together,” said Dr. Kolovich.

Dr. Kolovich explained to Chris just what was going on with his nerves. He compared Chris’ nerves to an electrical system and that several nerves cut during the amputation had formed neuromas, masses of scar tissue in the nerve that were basically a collection of ungrounded nerve endings.  “Essentially, all my nerves were just sitting there and sparking, causing that pain,” said Chris.

Dr. Kolovich recommended a nerve repair procedure called Targeted Muscle Reinnervation (TMR).  During the surgery, he would remove the neuromas, which were the source of the pain—and then repair the nerves to restore more normal nerve function.

A total of four neuromas were removed during Chris’s nerve surgery. Dr. Kolovich then reconstructed Chris’s nerves by connecting them to nerves located in chest muscle. In order to make that possible, there were large gaps that needed to be bridged. Dr. Kolovich used donated nerve allograft to bridge those gaps, allowing Chris’s nerves to regenerate and restore more normal signals to his brain.

recovery and renewal

Initially after surgery, Chris was still on his pain regimen. “But I could tell that the pain was starting to diminish, so little by little, we started slowly coming off pain medication.” About six weeks after surgery, he was fully off of all narcotics.

“Chris is a special person because he’s a salt-of-the-earth type of guy,” Dr. Kolovich said. “He never complained. He never whined. He never said, ‘why me.’ I think if you met Chris for the first time, you wouldn’t have known that he was in this horrific pain. He’s just got his life back.”

Now that Chris is living without chronic pain, he is able to do what he loves again. “My life did a 180. I love to spend time with my family. We like to go do things, travel. Before nerve repair surgery, I wasn’t able to do those things. I lived in pain every day of my life. Some days it was hard to get out of the bed. Sometimes I didn’t even want to eat,” Chris said.

“After having this surgery, I was able to go back and spend time with my kids. Go hang out with my friends, spend time with my wife, go back to work with no restrictions, coach my daughter’s softball team [and] have those experiences where I’m not just lying in bed all day and I can live a full life.”

 

Dr. Kolovich is a paid consultant for Axogen Corporation, however the views expressed are his own.

Each patient outcome is dependent upon the nature and extent of nerve loss or damage, the timing between nerve loss and repair, and the natural course of the patient’s recovery. These testimonials reflect the experience of the particular individual and may not represent typical results. Please consult a surgeon for more detailed information.

understanding common causes of nerve damage

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.

understanding the difference between acute and chronic pain

Much like the people who experience it, pain comes in all shapes and sizes. A sinus headache, a stubbed toe, a scraped knee or a broken arm—pain is a part of everyday life. But sometimes, that pain can transform into something more.

The day-to-day ouches and injuries we battle throughout our lives cause something known as acute pain.

what is acute pain?

Acute pain is the immediate reaction of your body that lets you know “Hey, that didn’t feel good, and you should stop doing whatever that was!” Though it hurts, this pain is a good thing—it lets your body know that a dangerous activity has just occurred, and you should course correct to avoid doing it in the future.

Acute pain doesn’t have a long shelf life. It’s there in the moment and then subsides not long after the initial incident. As soon as you’re healed, the pain goes away.

But what happens when pain lingers?

That’s where chronic pain comes into play. And there is a big difference between acute and chronic pain.

what is chronic pain?

Chronic pain is lasting. It drags on for weeks, months, even years without signs of stopping.

Most of the time when you injure yourself or have a surgical procedure, you feel pain. But after you heal, you feel fine again. Once in a while, that process goes awry. In response to trauma, the body’s nerves may react in a way that can lead to a different, chronic form of pain called neuropathy.

Some studies have found that approximately 30%–77% of individuals have pain six or more months after experiencing trauma.

Neuropathic pain, or nerve pain, has many potential causes and may manifest in a variety of ways. Sometimes it’s caused by the nerve physically being cut, for example, during a traumatic injury or accidentally during a surgical procedure. Neuropathic pain is extremely common among patients who have a cut nerve or had a limb amputated.

However, damage can also result from the nerve being compressed, injured or crushed—even if not actually cut. These types of injuries are most frequently incurred during an accident, a fall, playing sports, or any other activity that can stretch, compress, crush or cut nerves. This includes compression of the nerves due to repetitive stress, for example, carpal tunnel syndrome.

when to seek help

Once you understand the difference between acute pain vs. chronic pain, it will be easier for you to assess next steps. When pain is chronic (lasting more than three months) it’s important to take steps to find its cause and find a solution that lasts.

If you think your chronic pain is the result of a nerve injury, we might be able to help. You may have first experienced nerve pain in the months or years following surgery, trauma or amputation. Like most people, you probably never considered your chronic pain might be the result of nerve damage.

To find out if you’re a candidate for nerve repair, take our quiz.