Melbourne Hand Surgery 

Coronavirus update: We will be closed on Wednesday 8 April, but will reopen at 8:30am on Thursday 9 April. 

Melbourne Hand Surgery has mechanisms to protect our patients and staff while we continue to provide healthcare services. All consultations are now conducted via telehealth (phone or videoconference), except where we have previously confirmed the requirement for an in-person physical examination or wound care management.  Only emergency surgery is being conducted in hospitals for the foreseeable future, in keeping with Government directives. 

Due to the change in circumstances we will be closed on Fridays until further notice. If our practice is unable to physically open for business at any point in the coming weeks or months we will communicate this to existing scheduled patients via email and SMS (please do not attempt to reply other than with Y or N to an SMS, as the automated system does not facilitate this). Incoming telephone calls and receipt of voicemail messages may be temporarily affected by such a change. We will use this website banner to update you on changes to our practice and the availability of non-urgent procedures and surgery in the weeks and months ahead. Thank you for your understanding as our entire community works through these unprecedented and rapidly evolving times together (last updated: 4 April 2020).

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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