Your Guide to Peripheral Nerve Surgery: Common FAQs

If you’re living with nerve pain caused by surgical complications, injury, or compression syndromes, you’ve likely gathered more questions than answers along the way. Baltimore peripheral nerve surgeon Dr. Eric H. Williams understands that knowledge is powerful. He believes that when patients truly understand their condition and their options, they’re better equipped to choose a path toward meaningful relief. That’s why he takes time to address the concerns he hears most often—openly, honestly, and with your well-being at the center.

Your pain is real. Your voice matters. And there are paths forward—some you may not have discovered yet. 

Why Do I Need to See a Fellowship-Trained Peripheral Nerve Surgeon?

Peripheral nerve surgery requires specialized training that most surgeons don't receive during their standard residency programs. The difference in experience between a fellowship trained peripheral nerve surgeon and a more generally trained surgeon who has “seen a few” cases can be dramatic.

Many procedures that seem straightforward actually require a nuanced understanding of nerve anatomy and compression patterns. Incomplete releases, missed compression sites, and technical errors can result in continued pain and the need for revision surgery.

The diagnostic skills required to recognize nerve compressions can be challenging.  Recognizing positive Tinel signs, understanding nerve distribution patterns, and distinguishing between different types of nerve problems requires specialized experience.

Fellowship training provides intensive, focused education in nerve anatomy, surgical techniques, and patient selection. Dr. Williams completed his year-long fellowship with Dr. A. Lee Dellon, a world-renowned pioneer in peripheral nerve surgery, gaining expertise that few surgeons possess.  Dr. Williams then continued to work as Dr. Dellon’s partner for the next 15 years until Dr. Dellon retired.   

Dr. Williams emphasizes that patients should verify their surgeon's training and experience specifically in peripheral nerve surgery. Board certification alone doesn't guarantee expertise in this specialized field.

How Do You Decide Between Nerve Decompression, Nerve Reconstruction, or Nerve Removal?

The choice between decompressing, reconstructing, or removing a nerve depends on the nerve's condition and the likelihood of recovery, and the importance of the nerve itself, and its function.  This decision requires careful evaluation during both preoperative assessment and sometimes during surgery itself.  A careful discussion with the patient is important to explain what options are available and what evidence is present that would suggest the best potential course of action that might be able to provide a favorable outcome.  

Nerve decompression works best when the nerve itself is relatively healthy, still retains most of its function, and has excellent potential for recovery. Signs of remaining nerve viability include preserved sensation, strength, and muscle function.   

Nerve reconstruction may work best if a nerve is severely damaged with a major injury and  is a major nerve or provides a very important function. This has to be performed in a timely manner depending on the nerve and results are typically less predictable given our current technology and ability to harness and redirect the body's ability to heal. It may take months to see any results from nerve reconstruction due the the use of nerve grafts or nerve transfers that are designed to allow the nerves to recover as much function as possible. Patients who have major severe trauma to the neck, upper arm, or proximal sciatic or femoral nerves may require major reconstructive approaches that are only offered at a few specialized locations throughout the country, given that these injuries are so complex and can take years to recover from, and require entire multispecialty teams to help provide the best outcomes.  

Nerve removal or resection may be appropriate when a nerve is severely damaged, forms painful neuromas, causes symptoms that decompression can't address, may not warrant a major reconstruction, or a reconstruction is simply not feasible.  It is often amazing how an injury to a minor nerve can cause incredible discomfort.  In these settings, a major reconstruction may not be warranted, and removing the injured part of the nerve and placing it in a more protected environment may be a more viable option to try to improve a patient’s severe symptoms.  It is true that the patient will need to “give up something” to “get something” in return.  However, nerve resection is often a viable option for many patients with many different types of injuries. This technique has some limitations that will be discussed before making a decision on what may be best for a particular patient.   

Can You Help With Pain After Previous Surgeries?

Post-surgical nerve pain represents a significant portion of Dr. Williams' practice. Many patients develop nerve compressions or neuromas or other nerve injuries as complications from other surgical procedures, and these problems can go unrecognized or unacknowledged by the original surgeons. 

If they are recognized, the patient is frequently sent to pain management.  However, sometimes the pain persists. Then what?  There are options out there other than medications and spinal cord stimulators. While these may be effective for some patients, others may wish for an alternative.

Common scenarios include nerve damage after hernia repairs, knee replacements, hip surgeries, foot procedures, and various other operations. The nerve injury or nerve entrapment may occur during the original surgery or develop during the healing process.  It is also important to note that the surgeon performing the operation may not even be “at fault” if these things happen.  Complications can occur with surgery. Scar tissue occurs with surgery, and some surgical procedures or injuries just inherently have high risks.   

Severe persistent pain six months after surgery often indicates nerve involvement rather than normal healing complications. If your orthopedic surgeon says your joint replacement looks perfect, but you still have severe pain, a peripheral nerve problem may be responsible.

Dr. Williams can often identify specific nerves affected by previous surgeries through careful examination and diagnostic techniques. Treatment options include nerve decompression, neuroma removal, or nerve repair, depending on the specific problem.

Am I a Candidate for Surgery If I Have Multiple Areas of Pain?

Having pain in multiple locations doesn't disqualify you from surgery, but it does require strategic planning. Many patients suffer from several nerve compressions simultaneously, particularly after major surgeries or traumatic injuries.

Dr. Williams typically addresses one area at a time, starting with either the most severely affected region or the area most likely to provide significant relief. At times, a staged approach allows you to experience recovery before committing to additional procedures.

The decision about which nerve to address first depends on several factors. Sometimes the most painful area gets priority. Other times, Dr. Williams might recommend starting with a nerve compression that's easier to treat successfully, building confidence before tackling more challenging issues.

For patients traveling long distances, Dr. Williams occasionally performs multiple procedures during a single operation. This approach requires careful consideration of your overall health, the complexity of each procedure, and your ability to manage a more extensive recovery period.

How Does Surgery Help Reduce My Dependence on Pain Medication?

Reducing medication dependence represents one of the primary goals of nerve surgery. While this can not be guaranteed, this is always the goal. Pain medications can temporarily mask symptoms, but they don't address the underlying nerve compression or damage causing your discomfort.

Most patients who achieve good surgical outcomes can significantly reduce or eliminate their nerve pain medications. This includes commonly prescribed drugs like gabapentin, Lyrica, amitriptyline, and various prescription narcotic pain relievers that many chronic pain patients rely on daily.

Some patients discover that their remaining medications work much better after surgery. Pre-surgically, high doses might provide minimal relief. After successful nerve decompression, small doses often provide better comfort than the previous larger doses were able to provide because most of the underlying problem has been addressed.  

The secondary benefits of reduced medication use often surprise patients. Improved mental clarity, better energy levels, and fewer gastrointestinal side effects can be as life-changing as the pain relief itself.

The medication reduction process should be gradual and medically supervised. Dr. Williams works with patients to develop appropriate tapering schedules based on their recovery progress and individual response to surgery.  Patients may also be referred back to their pain management teams or primary care doctors to work on weaning medications if they have been on them for long periods of time.   

What Should I Expect During My First Visit?

Your initial consultation focuses on understanding your pain story and determining whether surgical intervention might help your specific situation.  Dr. Williams approaches each case as a puzzle requiring careful analysis.

Bring detailed descriptions of your symptoms, including when they started, what makes them better or worse, and how they affect your daily life. Descriptive language helps more than vague terms. "Lightning bolts down my leg" provides more useful information than "my leg hurts."

Your medical history timeline matters significantly. Dr. Williams needs to understand what treatments you've tried, what surgeries you've had, and how your symptoms have evolved over time. Bring copies of relevant medical records, imaging studies, and surgical reports.

The physical examination includes specific tests for nerve function and signs of nerve compression. Dr. Williams will examine your peripheral nerves, evaluate sensation patterns, and assess muscle strength in affected areas.

Be prepared to discuss your goals and expectations. Dr. Williams wants to understand what activities you hope to resume, what pain levels would be acceptable, and how committed you are to the recovery process.

The consultation isn't a commitment to surgery. Dr. Williams may recommend additional testing, suggest non-surgical treatments, or explain why surgery might not help your particular condition. Honest assessment prevents disappointing outcomes, unnecessary procedures, and added expenses.

How Do I Prepare for Surgery?

Proper preparation improves surgical outcomes and recovery experiences. Dr. Williams' office provides specific instructions, but general preparation principles apply to most nerve procedures.

These include:

• Arrange post-operative support. You'll need assistance with transportation, household tasks, and possibly personal care during the initial recovery period. Planning these details in advance reduces stress after surgery.  These vary depending on the procedure. 
• Prepare your home for limited mobility. Stock up on groceries, arrange necessary items at accessible heights, and consider shower modifications if needed. Simple preparations prevent complications later.
• Follow pre-operative instructions carefully. These requirements ensure safe anesthesia and optimal surgical conditions.
• Plan for extended time off work if your job involves physical activity. Office workers often return quickly, while those in manual labor need several weeks or months for complete recovery.

Understanding the recovery process helps set realistic expectations. Dr. Williams' office provides detailed post-operative instructions, but you are encouraged to ask questions about anything that seems unclear

How Long Does Recovery Take After Nerve Surgery?

Recovery timelines vary significantly depending on which nerve was treated, the extent of damage before surgery, and your individual healing response. Understanding the different phases of recovery helps set realistic expectations.

Surgical wound healing is the most predictable phase. Incisions typically heal within three to six weeks, although some procedures may require longer healing times. Tarsal tunnel releases often need the full six weeks, while some upper extremity procedures heal more quickly.

Your ability to return to normal activities follows a separate timeline. Office workers often resume desk duties within one to two weeks, while those in physical jobs may need two to three months. The key factor is avoiding activities that could injure the healing surgical site or disrupt nerve recovery.

Nerve regeneration is the most variable aspect of recovery. Some patients notice improvement within days, while others wait up to a year for full benefits. The general principle is that nerves regenerate approximately one millimeter per day, or about one inch per month.

Pain relief often occurs before sensation returns. Many patients find their burning, stabbing, or electric pain improves within the first few months, while numbness and altered sensation may persist longer.  This is one of the most variable aspects of recovery, and can be a source of frustration for patients. Typically, patients are able to see trends early on and those trends frequently continue.  If a patient is experiencing slow improvement, this typically continues.   

What If I Don’t Improve as Expected After Surgery?

Disappointing surgical results can stem from several factors, and understanding these possibilities helps determine next steps. Not every patient achieves the relief they hope for, but poor outcomes don't necessarily mean surgery was inappropriate.

Several factors can explain limited improvement after nerve surgery:

• Incomplete nerve decompression. Nerve compression often occurs at multiple sites along a nerve's pathway. Missing secondary compression points can limit your improvement significantly. This highlights why choosing an experienced peripheral nerve surgeon matters so much for achieving optimal results, as they will continue to look for other sights that may have been missed.
• Additional unidentified compressions. Sometimes nerve compressions exist that weren't apparent during your initial evaluation. Your symptoms might stem from problems at multiple levels, requiring staged procedures to address each compression point systematically.
• Incorrect original diagnosis. Sometimes there is a “differential” diagnosis.   Sometimes several medical problems can present the same way but not respond to the same treatment. Distinguishing between these conditions can be very difficult and requires specialized expertise that many physicians lack, and even then we are still “practicing” medicine.
• Insufficient recovery time. Dr. Williams recommends waiting a full year before concluding that surgery hasn't helped. Some patients continue improving throughout their entire first year of recovery, particularly those with severe nerve damage before surgery.
• Technical surgical issues. Previous procedures by less experienced surgeons may have been performed inadequately. This unfortunate situation sometimes requires revision surgery to achieve proper nerve decompression.

Revision surgery might be an option. Dr. Williams may be able to identify technical problems with previous procedures or locate missed compression sites during examination. However, revision procedures are more extensive, don't guarantee the same success rates as primary surgery, and are less predictable than primary surgical cases.  Revision surgery may be a complex decision tree for the doctor and the patient.