Do the nerves hurt when they regenerate
Nerve entrapment and injury
The description of the interventions was compiled with the greatest care. However, it can only be an overview and does not claim to be complete. The websites of the service providers and the personal consultation with the doctor or the surgical explanation in the respective operating facility provide further information.
The persons responsible for the content of this website do not guarantee the completeness and correctness of the information, as constant changes, further developments and concretizations are made as a result of scientific research or adaptation of the guidelines by the medical societies.
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If nerves are injured, pinched or squeezed, sensations, pain or paralysis can occur in the nerve supply area. In order to prevent irreparable damage to the nerves, nerve injuries such as those that occur in cuts or broken bones should be treated microsurgically as quickly as possible.
With the so-called bottleneck syndromes, it is important to free the pinched or squeezed nerve from its predicament so that it does not suffer any further damage. Such bottleneck syndromes usually occur in certain areas such as the wrist or ankle, where, due to the anatomical tightness, even slight swellings or increases in mass can lead to a crushing of the nerves. Triggers can be, for example, benign tumors, water retention in the tissue (edema), thickened tendon tissue, pieces of bone or muscle tissue that is too strong.
What happens during this procedure?
In the case of nerve injuries, the injured nerve is first exposed under a magnifying glass or microscope and - if possible - the two ends are sewn together again without tension. If the two nerve endings have been separated from one another by the injury to such an extent that they can no longer be put together without tension, a nerve transplant is carried out. For this purpose, depending on the length and thickness, the missing piece of nerve is replaced by an expendable cutaneous nerve that was previously removed from another location where the nerve is expendable. In order for the nerve to heal without tension, it must be immobilized for some time.
The bottleneck syndromes with entrapment of the nerves include, for example, the carpal tunnel syndrome in the area of the wrist, the tarsal tunnel syndrome on the ankle and the tibialis anterior syndrome on the lower leg.
In the case of carpal tunnel syndrome, it is possible to operate either “openly” or “minimally invasive” with special optical devices (endoscope) through a “keyhole”.
In open surgery, after a skin incision is made on the inside of the wrist, the connective tissue middle ligament (retinaculum flexorum) is cut in order to create more space for the nerves. If necessary, benign soft tissue tumors or a thickened tendon bearing tissue, which may exert pressure on the nerves, are removed.
In the minimally invasive (endoscopic) procedure, the narrow surgical instrument is inserted into the palm of the hand through two small skin incisions and the pressure on the affected nerves is relieved by severing the central ligament from “inside”. The main advantage of this approach is faster healing and less scarring.
At the end of the procedure, the incisions are sutured and a firm bandage is put on. Depending on the type of operation, a small plastic tube is inserted to drain off wound secretion, which is removed after a few days.
In the case of the tarsal tunnel syndrome, the tibial nerve is pinched in the so-called tarsal tunnel below the inner ankle, analogous to the carpal tunnel syndrome. The procedure is similar to that for carpal tunnel syndrome. Here, too, the nerve is relieved by removing the constricting ligament (retinaculum flexorum).
In the tibialis anterior syndrome, the tibialis nerve is squeezed in the area of the lower leg muscles. The muscles here are surrounded by a tough, not very stretchable shell. If the muscle mass increases, e.g. due to overload, water retention or bleeding after a muscle fiber tear, the nerve cannot escape and is squeezed. The therapy takes place here by splitting the coarse muscle skin (fascia), whereby the pressure on nerves and tissue is immediately relieved.
When does the doctor advise you to have this procedure?
In the case of injuries with severing of nerves, surgical recovery will always be sought whenever possible.
Surgical treatment of the carpal or tarsal tunnel syndrome is always advised when conservative therapy with rest, night splinting, or cortisone injections or shoe insoles or correcting incorrect walking technique has not brought about sufficient improvement. Surgery is usually recommended even if the squeezed nerve already shows clear signs of failure such as impaired tactile sensation or a weakening of the muscles it supplies.
An immediate operation is indicated in the rare acute or rapidly progressing courses. If the carpal tunnel syndrome is caused by other diseases or injuries, such as poorly healed fractures or dislocations of the carpal bones, this must also be addressed during the operation. Even in the case of an acute tibialis anterior syndrome, rapid surgery is usually advised to prevent further damage to nerves and muscles.
Whether you can operate with keyhole surgery (endoscopic) or whether an open procedure is necessary, the doctor must decide on the basis of the respective circumstances.
Which stunning method is usually used?
The interventions mentioned can be carried out in local anesthesia (reference: local anesthesia) or plexus anesthesia (reference: plexus anesthesia), depending on the location.
How long does the procedure take on average?
The duration of the procedure depends on the extent of the damage and the anatomical conditions.
Who may not be suitable for this procedure?
Injuries such as bruises are often very complex. In this case, it must be decided in which order bones, soft tissues, vessels, nerves and tendons are supplied.
During pregnancy, one is reluctant to operate a carpal or tarsal tunnel syndrome because the syndromes here are possibly caused by an increased tendency of the tissue to swell, which decreases again after the birth. Sometimes the bottleneck syndromes also occur in the context of certain underlying diseases such as diabetes mellitus or rheumatoid arthritis. In such cases, the doctor may first recommend optimal treatment for the underlying disease.
If the nerve is already so badly damaged that it has become more or less functionless and the muscles it supplies have already atrophied, the operation may no longer bring about any improvement.
How is the risk to be assessed?
Both the nerve sutures after injuries and the surgical interventions in congestion syndromes are considered low-risk interventions. As with any operation, of course, complications cannot be completely ruled out. Your doctor will explain to you in detail about rare complications such as secondary bleeding, injuries to neighboring structures, wound infections or excessive scarring before the procedure.
As small cutaneous nerves may be severed by the incision, an operation for congestion syndromes can leave a feeling of numbness in the surgical area.
The chances of success of the bottleneck operations are very good. Often the pain subsides immediately after the procedure. However, it can take a few weeks for the nerve to fully recover from the bruise. In very advanced cases, the numbness (sensitivity disorders) or muscle wasting that existed before the procedure no longer regress.
The results of the nerve suturing and nerve transplantation can only be assessed after 3-4 months. It is not always possible to fully restore the nerve function, so that limitations may remain.
What do you have to consider before the procedure?
If you take medication regularly because of other illnesses, you should inform your doctor or anesthetist in good time beforehand. If the operation is not performed as an emergency, some medications, such as blood-thinning substances, should be discontinued a few days before the operation.
What happens after the procedure and what should you watch out for?
Even with outpatient care for nerve injuries or congestion syndromes, you will remain under observation for some time after the procedure - until you feel fit to go home. The numbness of the arm or leg may continue for some time. You should not drive your own car on the day of the procedure and should not use public transport on your own. Let family or friends pick you up or take a taxi home.
The doctor can only decide on a case-by-case basis how long the immobilization must continue. After about 10 to 14 days, the firm bandage is removed and the sutures are pulled. Follow-up treatment with physiotherapy usually follows.
In the beginning, you should raise the affected hand or foot as often as possible and not let it hang down.
For interventions in the area of the foot or leg, you are usually prescribed thrombosis prophylaxis in the form of syringes for some time, which you should use as directed. If you cannot cope with the syringes on your own, you will have to organize someone to take care of the injections under the skin.
When does the next doctor's appointment usually take place?
On the day of the procedure, your doctor will tell you when you should come back for the next check-up. In your own interest, you should absolutely keep this appointment.
If you get swelling, severe pain or fever at home, or if the bandage is pressing, you should contact your doctor immediately. Even if you are unsure and still have questions about the normal course of healing, in practice no one will be angry with you if you call for advice
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