Upper extremity pain can follow any trauma or surgery. A number of different interventions, are performed each day on the upper extremity by orthopedic, vascular and plastic surgeons. These procedures may include:
- simple immobilization
- operative fracture and dislocation treatment
- joint arthroscopy
- total elbow or shoulder joint replacement
- vascular bypass
- soft tissue reconstruction for wound coverage
These treatments can all address the original problem (biomechanical, vascular, complex wound or any combination); however, a number of patients can be left with new, nerve related problems. This can be present as a compression neuropathy (numbness, burning), arm/hand functional loss, or chronic pain that persists beyond expected recovery time. A number of different pain treatments are offered by different specialists. Since the vast majority of these treatments focused on treating only the symptoms, a long-term solution is seldom found. Unlike other specialties, peripheral nerve surgery is focused on treating the anatomical cause of the chronic pain, ensuring the best possible chance for a cure.
You should see Dr. Ducic for chronic upper extremity pain following surgery or trauma, if your symptoms persist:
- After common reasons for prolonged post-operative pain (infection, bleeding, tumor, biomechanical abnormality, and others) have been excluded by your initial surgeon
- Despite the medical care prescribed to you by your surgeon or primary care physician
- Despite supportive care, such as activity and work adjustments, physical therapy
- After six months of prescribed medical and conservative care
Patients with chronic upper extremity pain may report joint pain, a skin pins and needles sensation, a burning sensation or numbness over any part of the arm/hand. Scars from previous surgery may be hypersensitive or painful. Daily hand use and professional activities can all be affected. Symptoms may be preset at rest and increased with activity. The extent of this presentation may vary, depending on the severity and etiology of injury, number of nerves involved and intensity of pain. Failure to intervene in timely manner poses a risk for chronic pain to evolve into a more complex presentation with involvement of your central and autonomic nervous system. These complex syndromes (like RSD or CRPS) make treatment far more challenging and difficult. Therefore, peripheral nerve surgery has an important role in treating chronic upper extremity pain, giving patients a chance to eliminate dependence on pain medications and improve their quality of life. Based on patient presentation and findings on physical exam, involved damaged sensory nerves are surgically removed so they can no longer continue to generate pain.
Alternatively, nerve decompression techniques can be applied to nerves that are not damaged, but compromised by adjacent swelling or scarring. This is particularly true if injury occurs in diabetic patients, who are at a much higher (several fold) risk then general population for experiencing compression neuropathy. Trauma or surgery in patients can offset otherwise clinically silent neuropathy, so patients may present with mixed symptoms of compression neuropathy and neuroma-related pain. Upper extremity pains and paresthesias therefore require comprehensive evaluation and treatment. An appropriate and timely evaluation and intervention by a peripheral nerve surgeon may help prevent irreversible nerve damage.
During surgery for chronic upper extremity pain:
- You receive anesthesia so you won’t feel any pain during the surgery.
- Unless you had a previous stent or bypass, a tourniquet is used to assist with a bloodless dissection
- An incision is made over involved upper extremity area(s) to access and remove damaged painful nerves and to release pressure on other compressed nerves.
- In most cases, the involved nerves are mainly sensory nerves, so no motor deficits are expected.
- The skin is closed in anatomical layers
- Hand use is allowed immediately following surgery, as tolerated.
- Peripheral nerve surgery for upper extremity pain is an outpatient procedure; your dressing will be removed about 5-7 days after surgery, while sutures are removed about two-three weeks later.
If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.