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.