Nerve Damage after Surgery : What Are Your Options?

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nerve damage after surgery

Can nerve damage after surgery be treated? Does this require more surgery or can it be treated without surgery? Let’s dig in.

What Happens When Your Nerves are Damaged?

nerve anataomyOne of the biggest issues we see after surgery is scarring around nerves (5). Think of a nerve as a garden hose. If you constrict one area, less water comes out the end. This is what happens when scar tissue forms around a nerve after surgery. The scar tissue constricts the nerve which reduces the transport of critical chemicals that the nerve needs to stay healthy.

A nerve can also be damaged by killing some or all of its fibers. The image to the left shows that a nerve is made up of many neurons (nerve cells) that are bundled into fascicles and then bundles of these make up the bigger nerve (6). In addition, the nerve is surrounded by a fatty sheath that acts like an insulator covering a wire (myelin) and when this gets damaged there can also be a problem with nerve function.

In summary, nerve damage is broken into neurapraxia (damage to the covering of the wire or myelin sheath), axontomeis (damage to the wire itself or the neurons), and neurontomesis (the nerve is torn or cut in half).

How Common is Nerve Damage After Surgery?

Somewhere between 1 in 200 to 1 in 50 patients will have permanent nerve damage after surgery. Temporary nerve injury is much more common, especially in spine surgeries. See below for the nerve-related side effects of several common procedures:

  • Hip replacement-0.2-0.6% (1)
  • Low back surgery-fusion (transient nerve injury lasting less than 3 months)-50-62% (2,3)
  • Shoulder replacement surgery-21% temporary nerve damage, 2% had permanent nerve damage (4)

What does Nerve Damage after Surgery Feel like? What are the Signs of Nerve Damage?

The biggest symptoms of nerve damage after surgery are usually numbness, tingling, burning, or muscle weakness or atrophy. Many times nerve issues after surgery are temporary, for example, many patients have nerve problems after surgery that only last for a few weeks to months (2,3). If they last longer than a few months, then they’re placed into the permanent nerve damage category and will likely need to be treated.

What Test Shows Nerve Damage?

There are a couple of tests to consider if you or your doctor suspect nerve damage after surgery:

  • EMG/Nerve Conduction Study-This is an electrical test of the nerve’s function. One issue is that it is highly specific, but has low sensitivity. Meaning that it will usually only pick up nerve damage that is more severe (7).
  • Ultrasound imaging of the nerve-This test can determine if the nerve size shows swelling and/or constriction. It works about as well as a nerve conduction study and is less invasive (8).
  • MR Neurography-This is a very specialized MRI scan that’s tuned to show the nerves (9).

How Long does it Take for Nerves to Repair after Surgery?

As above, most episodes of nerve damage after surgery last for a few weeks to a few months. If they last longer, then the rate of nerve regrowth is about an inch a month or faster. Hence, if the nerve is able to regrow, a nerve injury in the back could take years to regenerate the entire nerve from your back to your foot (10). However, many times scarring in or around the nerve prevents regrowth (11).

What Helps with Nerve Pain after Surgery?

Physical therapy may help. Medications that are commonly used to treat the nerve damage after surgery include:

  • Neurontin (Gabapentin) (12)
  • Lyrica (Pregabalin) (13)
  • Elavil (Amitriptyline) (14)
  • Topomax (Topiramate) (15)
  • Ultram (Tramadol) (15)

Ultrasound-Guided Nerve Hydrodissection with Orthobiologics

How can you break up scar tissue around nerves? Obviously, since the scar tissue was caused by surgery, using surgery to get rid of it can be a problem. However, there’s a new way to help nerves heal and get rid of the scar tissue which is called Ultrasound-Guided Nerve Hydrodissection with Orthobiologics. In this procedure, a nerve is visualized with ultrasound which is used to guide a small needle to inject fluid around the nerve to break up the scar tissue. In this procedure, which builds off our published work on treating spinal nerves with platelets, we inject the patient’s own platelet-derived growth factors that can assist nerve repair through cytokines like NGF, PDGF, and IG-1 (17,18). To see how this works on the median nerve in the carpal tunnel, see my video below:

Does this work? I cover two cases below.

Tanya’s Story

Tanya had a plastic surgery procedure on her gluteal area and ended up with a severe infection which caused scarring around the sciatic nerve. This basically gave her a dead leg, so when I met her she was wearing a special brace to walk, had significant numbness, and severe pain down the leg. She could barely go up or down stairs. I performed the Ultrasound-Guided Nerve Hydrodissection with Orthobiologics procedure a total of 4 times over about a year. I treated the entire length of the nerve, starting in the low back using fluoroscopy guidance and then using ultrasound-guided injections to treat the sciatic nerve down to the tibial and peroneal branches in the leg and foot. Where is she today? She no longer wears the brace, has gotten sensation back, and has limited pain. She does 30-inch box jumps in cross fit and is planning on competing in a bodybuilding competition!

Ivy’s Story

Ivy had a bad IV stick in her hand during which they injured the cutaneous branch of the ulnar nerve. Regrettably, she developed Complex Regional Pain Syndrome (CRPS) type 2 with pain so severe she couldn’t have anyone touch the hand most days. This made it very difficult to work with kids as a nurse practitioner, as they often grabbed that hypersensitive hand. I performed the Ultrasound-Guided Nerve Hydrodissection with Orthobiologics procedure a total of four times over about a year, injecting around the nerves in the hand, the ulnar nerve at the wrist and elbow, and the nerves in the neck. Her grip strength went from pitiful to normal. Today she has very little pain most days and can see kids without a problem. This is especially remarkable, as there are few treatment options for patients once severe CRPS sets in.

The upshot? Nerve damage after surgery that doesn’t go away after a few months can be devastating. However, newer non-surgical nerve repair techniques may be able to help.

__________________________________________________

(1) Fleischman AN, Rothman RH, Parvizi J. Femoral Nerve Palsy Following Total Hip Arthroplasty: Incidence and Course of Recovery. J Arthroplasty. 2018 Apr;33(4):1194-1199. doi: 10.1016/j.arth.2017.10.050.

(2) Liang JQ, Chen C, Zhao H. Revision Surgery after Percutaneous Endoscopic Transforaminal Discectomy Compared with Primary Open Surgery for Symptomatic Lumbar Degenerative Disease. Orthop Surg. 2019;11(4):620–627. doi: 10.1111/os.12507

(3) Mueller K, McGowan J, Kane S, Voyadzis JM. Evaluation of retraction time as a predictor of postoperative motor dysfunction after minimally invasive transpsoas interbody fusion at L4-L5. J Clin Neurosci. 2019 Mar;61:124-129. doi: 10.1016/j.jocn.2018.10.108.

(4) Lädermann A1, Lübbeke A, Mélis B, Stern R, Christofilopoulos P, Bacle G, Walch G. Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am. 2011 Jul 20;93(14):1288-93. doi: 10.2106/JBJS.J.00369.

(5) Pierluigi Tos, Alessandro Crosio, Pierfrancesco Pugliese, Roberto Adani, Francesca Toia, Stefano Artiaco. Painful scar neuropathy: principles of diagnosis and treatment. Plast Aesthet Res 2015;2:156-64. https://doi.org/10.4103/2347-9264.160878

(6) King R. Microscopic anatomy: normal structure. Handb Clin Neurol. 2013;115:7-27. doi: 10.1016/B978-0-444-52902-2.00002-3.

(7) Khambati FA, Shetty VP, Ghate SD, Capadia GD. Sensitivity and specificity of nerve palpation, monofilament testing and voluntary muscle testing in detecting peripheral nerve abnormality, using nerve conduction studies as gold standard; a study in 357 patients. Lepr Rev. 2009 Mar;80(1):34-50. https://www.ncbi.nlm.nih.gov/pubmed/19472851

(8) Emril DR, Zakaria I, Amrya M. Agreement Between High-Resolution Ultrasound and Electro-Physiological Examinations for Diagnosis of Carpal Tunnel Syndrome in the Indonesian Population. Front Neurol. 2019;10:888. Published 2019 Aug 26. doi: 10.3389/fneur.2019.00888

(9) Schwarz D, Kele H, Kronlage M, Godel T, Hilgenfeld T, Bendszus M, Bäumer P. Diagnostic Value of Magnetic Resonance Neurography in Cervical Radiculopathy: Plexus Patterns and Peripheral Nerve Lesions. Invest Radiol. 2018 Mar;53(3):158-166. doi: 10.1097/RLI.0000000000000422.

(10) Recknor JB, Mallapragada SK (2006). “Nerve Regeneration: Tissue Engineering Strategies”. In Bronzino JD (ed.). The biomedical engineering handbook (third ed.). Boca Raton, Fla.: CRC Taylor & Francis. ISBN 978-0-8493-2123-8.

(11) Zhang H, Uchimura K, Kadomatsu K (November 2006). “Brain keratan sulfate and glial scar formation”. Annals of the New York Academy of Sciences. 1086 (1): 81–90. doi: 10.1196/annals.1377.014.

(12) Griggs RB, Bardo MT, Taylor BK. Gabapentin alleviates affective pain after traumatic nerve injury. Neuroreport. 2015;26(9):522–527. doi: 10.1097/WNR.0000000000000382

(13) Khan J, Noboru N, Imamura Y, Eliav E. Effect of Pregabalin and Diclofenac on tactile allodynia, mechanical hyperalgesia and pro inflammatory cytokine levels (IL-6, IL-1β) induced by chronic constriction injury of the infraorbital nerve in rats. Cytokine. 2018 Apr;104:124-129. doi: 10.1016/j.cyto.2017.10.003.

(14) Matsuoka H, Suto T, Saito S, Obata H. Amitriptyline, but Not Pregabalin, Reverses the Attenuation of Noxious Stimulus-Induced Analgesia After Nerve Injury in Rats. Anesth Analg. 2016 Aug;123(2):504-10. doi: 10.1213/ANE.0000000000001301.

(15) Codd EE, Martinez RP, Molino L, Rogers KE, Stone DJ, Tallarida RJ. Tramadol and several anticonvulsants synergize in attenuating nerve injury-induced allodynia. Pain. 2008 Feb;134(3):254-62. Epub 2007 May 25. https://www.ncbi.nlm.nih.gov/pubmed/17532139

(16) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. Published 2017 Nov 25. doi: 10.1186/s40634-017-0113-5

(17) Sowa Y, Kishida T, Tomita K, Adachi T, Numajiri T, Mazda O. Involvement of PDGF-BB and IGF-1 in activation of human Schwann cells by platelet-rich plasma. Plast Reconstr Surg. 2019 Aug 27. doi: 10.1097/PRS.0000000000006266.

(18) Sánchez M, Anitua E2, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opin Biol Ther. 2017 Feb;17(2):197-212. doi: 10.1080/14712598.2017.1259409.

This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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24 thoughts on “Nerve Damage after Surgery : What Are Your Options?

  1. Robin Baumgartner

    Hi Dr. Centenno, I was wondering if this procedure would work with someone who has nerve damage due to guillain barre syndrome.

    1. Chris Centeno, MD Post author

      Possible, but we have not treated many of these patients, mostly post-surgical nerve injury or compression syndromes.

  2. Edward D Hochard

    I still have numbness in the front of my knee after total knee replacement and its hard to kneel on the knee. Any thoughts?

    1. Regenexx Team

      Hi Edward,
      This is, unfortunately, not unusual as nerve damage is one of the many risks of joint replacement.

  3. Wilma

    Dr Centeno I’m always looking to read your articles. My mother had a knee nerve ablation done to relieve pain after 2 failed knee surgeries including a revision with a fracture. Nothing works for her, the pain never goes away to the point that she cannot tolerate to stand or walk. Too many medical opinions in Puerto Rico where the surgeries where done, and Orlando Florida where she visit 3 orthopedic surgeon and was refer to a pain management doctor that perform the knee nerve ablation following the test process, but relieve only last a few days And the pain management doctor blame the fracture, but the orthopedic said it is cemented and should be ok. Now they said the problem was her back L3 herniatic disc that is causing all the pain. I’m hoping for a study or research that can look at this medical scenario. Dr. Centeno God bless you, and all do with steam-cell research.

    1. Regenexx Team

      Hi Wilma,
      It is common knowledge that low back issues can cause knee problems. What was the knee surgery that needed the revision?

  4. Wilma

    Hi Dr.Centeno. The reason for the L TKA knee revision was due to loosening of hardware. The 1st surgery was July 2015 and the revision was March 2017, and She ends with more pain and more difficulties. Pretty much she is restrain to bed. I moved her to Florida for pain management and They did the nerve ablation at the knee, because she respond well to the trial shots. But it doesn’t last long.

  5. Randy

    I had surgery for scoliosis when I was 16, 19~ years ago, they said my nerves would heal. I still can’t feel anything other then pressure on my back all the way from lower to my upper back. about 2-4 inches to each side of the scar which of course runs from lower to upper back.
    Not the only nerve damage I have, when I was 3 I had a trach so I could breathe and they severed some nerves that control swallowing lower then my mouth. ie my mouth swallowing and associated muscle groups is the only force to push food down.

  6. Norm Jalette

    Hi I like your article about sciatic nerve pain after surgery.
    Naturally, I have a real pain from after having a fusion of the spine just over 2 years ago: been using pain killers for just as long { as well as oxycodone/acetaminophen 5-325} that does not help much at all!
    I am totally willing to go back for surgery; and hopefully have ‘something’ done about it. My physition does not help with this and am searching for help, PLEASE?

    1. Regenexx Team

      Hi Norm,
      This is unfortunately very common. Please see: https://regenexx.com/blog/pain-after-back-fusion-adjacent-segment-disease/ and https://regenexx.com/conditions-treated/spine/ We’d need more information to advise. We’re currently doing Insurance and Medicare covered Telemedicine appointments so we can see what’s going on from the comfort and safety of your home. To do that, please use the LEARN MORE button on the top red section, here: regenexx.com

  7. Fabiene

    My mom had a hip surgery and she woke up from the anesthesia with a drop foot. Doctor said it would take 3-6 months to heal her nerve but it’s been almost 7 months already and nothing has changed. She feels her leg really heavy and she can’t move her foot. Another neurosurgeon prescribed Gabapentin 300mg for 30 days now. Is there anything else we can do?

    1. Chris Centeno, MD Post author

      Yes, as discussed in this blog, nerve hydrodissection of the scarred down nerve may help.

  8. CJ

    Hi Dr Centeno, I’ve been to many different hospitals recently and nobody is able to help. I cut in my middle finger back in December 2018 and my fingertip is still numb. They say I’ve damaged a neuron. The skin always looks swollen and I know something is blocking my nerve because there’s a little swelling just above the cut. A few months ago pus came out of it after “treating” it myself. People tell me I should live with it but it’s my dominant hand and effecting my daily life with everything I do.

    1. Chris Centeno, MD Post author

      Sounds like this could be an infection, so getting this looked at to rule out infection would be a good idea. On whether we could likley healp this kind of problem if the nerve is just scared down, that’s likley.

  9. Siobhean

    Hello, I had a grade III open inward ankle dislocation without fracture 11 months ago. All the ligaments were severed on the outer side and probably nerves too. Since surgery the numbness has moved around the top of my foot but now has settled at the scar tissue around the ankle and halfway down the foot towards the toes. My physio is using a kind of electronic pen to send pulses to the nerves to stimulate them. Every now and then I get very strong whip like shots of extreme pain the in the area to the degree that my leg jolts. Is this a positive sign that the nerves are recovering? Luckily I have regained near full movement of my foot so if the numbness is permanent, that is a small price to pay!

  10. Namgay Dorji

    HI my wife has done 6 cycles chemotherapy followed by lumpectomy (right side) 6 month before and now she is feeling what half body numbness & tingling and even she feel difficult to talk.As soon as she experienced ,we visited to hospital and Dr prescribed her the medicine called Neuromax forte tab but she got whole body allergic after taking 1tab each in morning and evening for 3 days.so Dr recommended not to continue and her illness(numbness & tingling ) still hanging .Any suggestion please.I will be grate if you could kindly share experienced and any appropriate medication for her.

    1. Chris Centeno, MD Post author

      These are issues that need to be brought up with your doctor.

  11. Greg

    Interesting theory. I have chronic nerve (hypersensitive) damage, because of my original injury which took 10 surgeries with two fusion’s and multiple laminectomies. The original surgery was a purcantanius discectomy, in which the needle nicked the nerve through L4/5 area. I have been diagnosed with hyperactive in this area. When the dr. did tested my reflects the reflects are greater on one side as the other. I just had a Nevro implant to shut off the neurons to the damaged left side going down to my lower legs. I wonder if the hypersensitivity in this region is causing and inhibiting the signals by the Nevro system. I take neurontin to help but it it still raw deep pain down my leg. I plan to bring up this theory to my dr. at my next follow up. I have hope in this Nevro system to be able to turn off the neurons that are sending these pain signals to the brain.

  12. Iris

    Is hydrodissection performed with a local or stronger sedation? This sounds pretty painful. What if’s patient is needle phobic? Thanks.

    1. Chris Centeno, MD Post author

      Depending on the clinic, hydrodissection can be performed with IV sedation. For example, in Colorado, we have that capability so many patients choose to be sedated.

  13. Avril Cruickshanks

    I have nerve end damage due to having mesh put in then taken out from a hiatus hernia. Is the “ultrasound guided nerve Hydrodissection” suitable for this kind of damage. It is just below my breast blown in the middle of my chest. I’m on 12 Gabapentin daily. Cannot take pregabaline due to side effects. I’m on 50mg of amitriptyline nightly. Tramadol done nothing for it and have never heard of Topomax. I stay in the U.K. and don’t know if this is available on the NHS?

    1. Chris Centeno, MD Post author

      Yes, nerve hydrodissection may help. Not on NHS, but we do have a UK clinic, see https://regenexx.com/providers/algocells/

  14. william A Leblanc

    Hello Dr. I have been dealing with pain and numbness, after my shoulder surgery. I am completely healthy I am not diabetic nor is my thyroid bad. I have went through all the test emg that showed that I have neuropathy in my hands and feet. Is there any help or resolution that you can give me. I have been very active at my job plus I have been in martial arts. This all stems from where I had fallen off a ladder at work I caught my self with my left arm. I had been dealing with frozen shoulder I had surgery and a manipulation its been going on two years.

    Thank You,
    Bill LeBlanc

    1. Chris Centeno, MD Post author

      Bill, has anyone imaged your neck with an MRI scan?

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