Chronic Joint Pain

Do you suffer from chronic joint pain? Have surgeries, injections and pain medications been unsuccessful in providing long term pain relief? If this sounds like you, then nerve surgery may be the solution to achieving long term relief from chronic joint pain.

Nerve related joint pain is often overlooked as a source of pain in a joint.  Oftentimes, patients may be evaluated by multiple medical providers and told that there is nothing wrong with their knee/hip/ankle/shoulder.  MRIs and x-rays may also suggest that there is nothing wrong, yet the joint pain persists. When patients are left questioning how to find relief from chronic joint pain, nerve surgery may be the answer.

Understanding Nerves and Joint Pain

There are many small nerves that supply feeling to each of the joints in the body. When these nerves become damaged, they send pain signals to the brain, resulting in chronic joint pain.

In most cases, the nerves are directly injured either by trauma to the nerve or by a surgery that injured the nerve or caused scarring around the nerve.  The affected nerve sends faulty signals to the brain indicating that there is pain in the joint even though there is no apparent reason for the pain. Oftentimes, there is no structural damage to the joint, but nerve pain can sometimes accompany an orthopedic injury.  The pain can be acute, meaning recent onset, or it can be chronic, meaning the pain has been around for years.

Some of the common causes of nerve related joint pain include:

  • Falling on the joint
  • Knee replacement
  • Ankle sprain
  • Car accident
  • ACL injury
  • Arthroscopic surgery
  • Meniscus tear
  • Rotator cuff surgery
  • Sinus tarsi syndrome

What are the symptoms of nerve related joint pain?

Differentiating nerve pain in joints from other causes can be difficult and easily missed.  Imaging studies and EMGs often don’t reveal any injury.  So how do you know if you have nerve related joint pain?  Nerve related pain is different from orthopedic pain.  Patients with nerve pain most often describe the pain as a burning pain, electric shock pain or zinging pain that radiates away from the joint.  They are often woken up by the pain.  The skin over the joint can be extremely sensitive to touch.

How is nerve related joint pain diagnosed?

The first step in diagnosing the cause of joint pain is to rule out any orthopedic injuries that may be present. X-rays and/or MRIs may be required to evaluate the ligaments and joint structures. If no abnormalities are found, the next step is to evaluate the nerves providing sensation to the affected joint. If any structural injuries are found, they should first be addressed by an orthopedist. If the pain persists following orthopedic intervention, then it may be time to consider nerve surgery. It is quite common for us to perform nerve surgery on patients who have already had joint surgery and experience continued pain.

Nerve related joint pain is diagnosed by physical exam and by injecting the nerve with local anesthesia.  During the exam, a Tinel’s sign test is performed, where the nerve is gently tapped. If the zinging pain is reproduced, it is indicated that the pain is likely nerve related.  After the troublesome nerve has been identified, it is injected with a small amount of numbing medication (not steroids); this is known as a “nerve block.”  The medication only lasts a day or so.  If the pain is reduced or gone, then the pain is nerve related.

What procedure do we offer?

At The Institute for Advanced Reconstruction, we perform a surgical procedure called a neurectomy to the nerves causing the pain.  Small (1-2 inch) incisions are made in the area where the nerve was injected.  The nerve is identified and surgically cut.  The end of the nerve is then placed into a nearby muscle so that is does not continue to cause pain.  These nerves only supply feeling to the joint, so the area where the nerve is cut will still work normally, there just may be a little numbness in the area. This procedure is often referred to as “joint denervation surgery.”

This procedure is commonly performed to alleviate knee pain and ankle pain, but can also address other areas of pain, such as hip pain, wrist pain, shoulder pain, elbow pain and carpometacarpal joint pain (thumb joint).

What is the recovery like after this procedure?

This minimally invasive procedure is usually performed on an outpatient basis. Patients are often able to return to work within one week. Full recovery from this surgery usually takes around two to three weeks.  Following recovery from surgery, patients are often pain free and able to resume their normal pre-injury lives.

Joint denervation surgery can provide relief for chronic joint pain resulting from a number of injuries. The bottom line is quite simple, by stopping the signals sent by a nerve from the joint to the brain, we are able to prevent “pain signals” and alleviate chronic joint pain.

 

Please contact The Institute for Advanced Reconstruction if you are interested in learning more about this procedure.



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