Melbourne Hand Surgery 

Please note: We do our best to accommodate emergency and urgent referrals upon receipt of your doctor's referral. Dr Tomlinson is currently booked some months in advance so if your condition is urgent or you wish to be placed on our "Waiting for an Early Appointment" list to see Dr Tomlinson or Mr Babazadeh please provide us with your doctor's referral and your registration forms so that we can facilitate an urgent review. We strongly encourage individuals who are seeking non-surgical treatment of Dupuytren's contracture with Dr Tomlinson to seek placement on our waiting list and provide us with details of your availability, so that we can contact you in the event of an earlier appointment becoming available. If you have recently sustained a hand or wrist injury you may wish to explore the option of the Action Rehab Urgent Care Clinic, where your injury will be assessed and managed by an experienced hand therapist.

Peripheral nerve surgery for chronic pain

woman in rain yellow jacket handsPeripheral nerve surgery can relieve chronic pain in some patients. Broadly speaking, there are three instances where peripheral nerve surgery may be of benefit.

1. Nerve Compression

Firstly, when the chronic pain is caused by nerve compression. This includes the relatively common conditions of carpal tunnel syndrome and cubital tunnel syndrome. Nerve compression can develop for no particular reason but it can also be the result of trauma or surgery. Relief of this type of pain can be achieved by surgical decompression. For individuals who have nerve compression as a result of trauma or surgery, a good result from surgical decompression is most likely if the pain can be completely temporarily relieved by injection of local anaesthetic at the area of suspected compression.

2. Neuroma

Secondly, surgery may be of benefit when the chronic pain is caused by a neuroma. A neuroma can grow at the site of an injured nerve, and comprises regrowing nerve ends that form a little ball because they have nowhere to grow. A neuroma is often exquisitely tender to pressure. Removing the neuroma and placing the cut nerve end where it will be less likely to be subjected to pressure can be of great benefit to individuals who have chronic pain from a neuroma.

3. Denervation Surgery

man holding dumbellThirdly, surgery may be of benefit when the chronic pain affects a region of the body that can be denervated - where the nerves to the body region (often a joint) are severed. This treatment is only suitable in select cases. The treatment cannot be guaranteed and may not be permanent in all patients, as it is possible that a) not all the involved nerves will be able to be identified, and b) in some instances the nerves may regrow. Often numbness of the skin is a tradeoff of the surgery - while the cut nerve no longer transmits pain signals, it also does not transmit sensation signals.

Diagnosis

Nerve conduction studies can diagnose nerve compression and are recommended prior to decompression if there is any doubt or question about the diagnosis. If a neuroma is suspected your surgeon may conduct a diagnostic "test" where local anaesthetic is injected at the site of the suspected neuroma to see if this temporarily relieves your symptoms. This type of "test" may also be tried prior to denervation surgery.

References & further reading

 

FRACS

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