WHAT YOU SHOULD KNOW
After laceration or surgery around nerves, scar tissue forms. The scar tissue causes the nerve to attach to nearby structures. Movement of the arm then places pressure and/or traction on the nerve via the encasing scar tissue. Even without movement, the scar tissue disrupts the nutrition to the nerve causing it reduced blood supply. All of the above cause significant nerve pain that is usually constant around the clock and difficult to treat by any method.
MEDICAL HISTORY
The main complaint of most patients is a constant unrelenting special type of pain that eventually becomes recognized as coming from nerve tissue specifically.
EXAMINATION
All the functions of the affected nerve are tested. Reproduction of pain in that nerve is tested with external pressure, and traction.
ADDITIONAL TESTS
Electrical nerve tests will clearly demonstrate which nerves are functioning and which are not along with actual numbers to measure the severity of damage.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL WRAPPING | NEUROMA RELOCATION | |
| CONSISTS OF | Therapy and medications to control pain | Covering nerve with new tissue that has good blood supply, good traction gliding, and good padding from outside pressure | Burying the cut end of a sensory nerve where it will not be stimulated by motion or contact |
| FEATURES | Medications are very sedating | Nerve is wrapped either in a vein or a layer of the body called fascia that is part of a known blood supply | Placed deep in muscle tissue or inside the center of a bone |
| ADVANTAGES | Avoids surgery | Changes the actual nerve environment | Displaces from contact surface of body or away from moving tendons |
| DISADVANTAGES | Limited effect | Some new scar forms eventually | Pain relief incomplete, only good for small sensory nerves |
RECOVERY
Rarely does a patient with persistent nerve pain ever experience complete relief. Rehabilitation takes several months of desensitization and pain control measures. Patients are best cared for overall in a multidisciplinary clinic designed specifically for pain management. Nerve gliding exercises are performed daily to lessen the chance of repeat scar formation becoming a source of recurrent nerve pain.
