Peripheral Nerve Surgery

What Is Peripheral Nerve Pain?

The peripheral nervous system consists of all the nerves that are outside of the brain and the spinal cord: the nerves in your arms and legs, in your face, and in your chest and abdomen. Whether caused by injury, surgery, or conditions such as diabetic neuropathy, damage to the peripheral nerves can lead to chronic pain that is difficult to diagnose and find solutions to treat.

The Peripheral Nerve Surgery Program in the Section of Plastic Surgery involves cutting-edge surgical treatment for pain caused by injury and/or compression of nerves.

Surgery for Chronic Pain

Some causes of chronic pain can be successfully treated with surgery. Chronic pain after surgery, accidents, trauma, and sports injuries that has not been relieved by first-line methods may be due to injury to peripheral nerves. Patients often visit several doctors and engage in multiple therapies including physical therapy, medications, orthopaedic treatment, or spinal nerve blocks without significant relief. Medications often only reduce or mask the symptoms — unfortunately, patients with chronic pain from peripheral nerve injury rarely experience lasting relief from medications.

New techniques have been shown to reduce or eliminate pain for many of these patients. Michigan Medicine is one of a handful of institutions currently offering this surgery as an option for patients who may have exhausted other methods of treating their pain.

Who Is a Good Candidate for Nerve Surgery?

The optimal patient for potential surgical treatment for peripheral nerve injury has:

  • Pain in a specific area for more than three months that has not been relieved by other methods like physical therapy or medications.
  • A prior workup by other specialists such as orthopaedic surgeons, physical medicine doctors, pain specialists, or neurologists — without discovering an obvious cause for the pain.
  • Prior tests can be particularly helpful, such as EMG/NCV, diagnostic nerve blocks, and 3T MRIs.

Pain lasting more than 3 months following:

Prior surgery

  • Knee replacement
  • Leg, ankle or foot operations
  • Hip replacement
  • Abdominal surgery, laparoscopic surgery, abdominoplasty, etc.
  • Hernia repair
  • Mastectomy
  • Breast reconstruction or augmentation
  • Chest surgery

Trauma

  • Falls
  • Sports injuries (ankle sprains, ligament tears)
  • Shoulder, neck and facial surgery

Others

  • Significant weight loss with pain in one area
  • Diabetes — new onset of foot pain

NOTE: If you smoke, recently quit smoking or have been unable to stop completely, or you are exposed to second-hand smoke, you may not be a candidate for surgery. Primary and secondary smoking decreases blood supply to the body's tissues, resulting in prolonged wound healing, skin loss, infection, increased scarring, and a number of other complications related to the kind of procedure performed.

How Is the Procedure Performed?

Diagnosing peripheral neuropathy can be difficult, and its contribution to chronic pain is not well known. The process includes a thorough patient history and physical examination to identify the cause of the pain as a neuropathic disorder and whether there is an appropriate surgical solution. Often, additional diagnostic tests such as MRI or EMG are used.  

Our team of surgical professionals often find that relieving pressure on a specific nerve or dividing the nerve above the site of injury can decrease or even eliminate a patient’s chronic pain. Typically, these operations can be accomplished through relatively small incisions in an outpatient operation. Dividing the nerve(s) can result in a limited area of numbness of the skin — often a welcome trade-off for the pain.

A Multidisciplinary Team Approach to the Treatment of Chronic Neuropathic Pain

Often, a team approach is beneficial in diagnosing the cause(s) of pain and identifying treatment plans. Once a month, physicians from Plastic Surgery, Neurosurgery, Anesthesia Pain Management, Neurology, Physical Medicine and Rehabilitation, and Prosthetics see patients together in a team-based clinic. This collaboration can help to save multiple visits with different providers.  If needed, your appointment will be made in this location.

The type of procedure depends on the location and cause of the pain. In many instances, the pain results from compression of (pressure on) a specific nerve or group of nerves. In such cases, relieving the pressure relieves the pain. This can usually be accomplished through relatively small incisions during an outpatient operation. In other cases, the nerves may need to be divided and rerouted. This can result in an area of limited numbness of the skin — often a welcome trade-off for the pain.

Planning for Your Consultation

Identifying the cause of your pain is not always straightforward. Many patients will have seen several other physicians, physical therapists, or pain specialists without complete relief of their pain. We will work with you to get the necessary information ahead of time regarding these other consultations and/or interventions. It may be helpful for you to have a temporary block of the involved nerve prior to your consultation to determine your diagnosis.

Planning for Your Surgery

The first step is to schedule a personal consultation with your surgeon by calling 734-998-6022. During the initial consultation, you should expect:

  • To provide a complete medical history, including information about previous surgical procedures; past and present medical conditions; and any medications or herbal supplements you are taking.
  • Your surgeon to conduct a complete physical examination.
  • To possibly have a nerve block (local anesthetic injection) to diagnose the cause for your pain.
  • To discuss possible risks and complications of the procedure.

Preparing for Your Surgery

You will be given a preoperative information packet that explains everything you should do and know before your surgery date. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.

Where Your Surgery Will be Performed

Your procedure will take place at the University of Michigan Hospitals, which provide state-of-the-art surgical suites and recovery areas. The majority of these procedures are completed on an outpatient basis.

Types of Anesthesia

You will remain comfortable throughout the entire procedure. In most cases, general anesthetic is used so that you will sleep throughout the procedure. Intravenous sedation augmented with local anesthesia is also an option for some patients.

After Your Surgery

It is very important that you follow your surgeon's instructions in order to promote healing. Also, it is important that you attend all follow-up appointments so your surgeon can assess your long-term results and answer any questions or concerns you may have.

Make an Appointment

To schedule a consultation to discuss whether you are a candidate for peripheral nerve surgery, call 734-998-6022.