Baltimore Peripheral Nerve Surgeon Dr. Eric H. Williams Helps Patients With Post-Surgical Neuromas Relieve Their Pain
When you had surgery, you didn’t expect it to increase your pain. However, procedures on the abdomen or extremities can sometimes lead to the development of painful neuromas. Baltimore peripheral nerve surgeon Dr. Eric H. Williams has extensive experience helping people with neuromas after surgery on the abdomen or extremities find relief from their chronic neuropathic pain—and he may be able to do the same for you.
Diagnosing a Neuroma After Surgery
A neuroma is a non-cancerous growth or swelling of nerve tissue that forms when a nerve has been damaged from any means. Neuromas can develop in various parts of the body, such as those in the hands, feet, or limbs.
Neuroma symptoms can include:
- Pain. Neuromas can cause persistent or intermittent pain in the affected area. This pain might be sharp, burning, or feel like an electric shock.
- Numbness or tingling. Some people with neuromas may experience sensations of numbness, tingling, or a feeling of pins and needles in the affected area.
- Sensitivity. The affected area might become uncomfortably hypersensitive to pressure and touch. Pressure on the neuroma can exacerbate pain or discomfort.
- Discomfort with movement. Activities that involve movement of the affected area may worsen the symptoms. For instance, walking or wearing tight shoes can aggravate neuromas on your feet.
The symptoms of a neuroma may come and go or persist over time as an uninvited guest in your day-to-day routine. Your symptoms may vary in intensity depending on factors such as activity level, local touch, trauma, or pressure on the affected area.
Some degree of post-surgical pain is normal after any operation. However, if you are still experiencing significant pain three to six months after your surgery, you may have suffered damage to your peripheral nerves.
A nerve block can be used as a diagnostic tool to determine if you have a neuroma and which nerve is causing your symptoms. If a nerve block temporarily relieves your pain, the problem can be addressed surgically. If it is unsuccessful in relieving your pain, surgery will not be an effective solution.
Surgeries That Can Lead to the Development of a Neuroma
Surgeries involving the abdominal wall or extremities can sometimes lead to the development of neuromas due to nerve damage or irritation during the procedure.
Any surgical procedure can lead to a neuroma, but a few abdominal surgeries that we see the most often that can lead to neuromas include:
- Hernia repair surgeries
- Gallbladder surgery (cholecystectomy)
- Cesarean sections (C-sections)
A few examples of surgery on the extremity or chest that can lead to neuromas include:
- Tendon repair surgeries on the ankles
- Limb amputation
- Orthopedic surgeries such as knee replacements or hip replacements
- Breast cancer surgery, such as mastectomy, lumpectomy, or reconstruction
A Neuroma Doesn’t Necessarily Mean a Surgeon Has Been Negligent
Contrary to popular belief, a post-surgical neuroma doesn't automatically indicate that your surgeon has been negligent. Surgery, by nature, involves invasive procedures with sharp and hard instruments near soft and delicate nerves.
Even when surgeons adhere meticulously to gold-standard techniques, complications can still arise. Such complications are an acknowledged aspect of the surgical consent process and underscore why medicine is termed a "practice."
It is also possible that your nerves may have been injured or at least partly dysfunctional prior to surgery. Some patients continue to have pain after a procedure that was supposed to help them because they had two problems: a peripheral nerve problem and the problem that initially led them to seek treatment.
How a Peripheral Nerve Surgeon Can Help
Pain medications might offer temporary relief from neuroma symptoms, but simply masking the pain signals doesn't address the root problem. When nerves are entrapped in scar tissue or injured, targeting the nerve causing the issue is the only way to find lasting pain relief.
As a peripheral nerve surgeon, Dr. Williams treats neuromas using various techniques aimed at alleviating pain and improving function.
- Nerve decompression. For neuromas caused by nerve compression or entrapment, such as Morton's neuroma (a common neuroma in the foot), nerve decompression techniques aim to alleviate the pressure on the affected nerve.
- Neuroma excision with burial. When the nerve is causing significant pain but is not crucial for function, surgical excision of the neuroma may be performed. After removal, the nerve endings might be buried within nearby tissues to prevent them from causing discomfort at the skin's surface.
- Nerve reconstruction of grafting. When preserving nerve function is important, nerve reconstruction techniques can involve rebuilding the nerve with a piece of healthy nerve from another part of the body or a donor nerve to bridge the gap between damaged nerve ends to try to restore continuity and recover function.
- Regenerative Peripheral Nerve Interface (RPNI). RPNI involves creating a biological interface between a severed nerve and an adjacent non-nervous structure, such as a muscle or dermal grafts to cap the nerve ending.
- Targeted muscular reinnervation. This technique involves redirecting the injured nerve endings to innervate a nearby functioning muscle to "quiet down" the nerve and reduce the formation of neuromas by giving the nerve another place to grow.
- Nerve transfer. Surgically rerouting a healthy nerve to the affected area can restore function and potentially alleviate pain.
What to Expect After Surgery
Every person’s recovery experience is unique, but our patients often report dramatic improvements in their overall quality of life. Consider these examples:
- Back to work. Our patient, a young man with arm pain from a past work injury, was able to return to work after resection of a neuroma of the lateral antebrachial cutaneous nerve that innervated the scar from his previous tennis elbow operation.
- Able to walk and wear shoes again. Dr. Williams worked with Dr. John Senatorre, DPM, a podiatrist, to help a patient with a bunion and two previous Morton's neuromas in the same foot to find relief from her pain so she could walk and wear shoes comfortably.
- No more narcotic medications. Our patient suffered for four years of chronic pain in the groin and lateral thigh after a hysterectomy. We removed the right ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous nerve. She is now completely off her narcotic medications, her pain levels have improved, and there was no negative impact on her sexual function.
- Complete resolution of pain. Our patient had more than a year of pain in the groin and testicle after a past hernia repair. We laparoscopically removed the ilioinguinal, iliohypogastric, and genitofemoral nerve and decompressed the lateral femoral cutaneous nerve. Now, he has had essentially complete resolution of his pain with no negative impact on sexual function.
- Intimacy restored. Our patient experienced debilitating pain in the perineum area, the left internal vaginal wall, and the left labia after her vestibulectomy. We suspected that the nerve endings healed abnormally after a diagnostic block with local anesthetic temporarily resolved her pain. We elected to remove these nerve branches due to the amount of life-limiting pain that she was in. After surgery, she was able to enjoy normal activities and pain-free sexual function again.
To learn more about the results Dr. Williams has achieved with his patients, refer to the testimonials section of our website.