Causes of Nerve Damage After Surgery and How to Treat It - Regenexx (2022)

ByChris Centeno, MD /

In this article:

  • Overview
  • Diagnosis
  • Recovery time
  • Treatments
  • Nerve damage patients’ stories

One of the biggest issues we see after surgery is scarring around the nerves (1). The most common symptoms of nerve damage after surgery are usually numbness, tingling, burning, muscle weakness or atrophy. Many times the symptoms are temporary, for example, many patients have nerve problems after surgery that only last for a few weeks to months (2,3). If they last longer than a few months, then they’re placed into the permanent nerve damage category and will likely need to be treated.

What Happens When Your Nerves Are Damaged?

Think of a nerve as a garden hose. If you constrict one area, less water comes out. This is what happens when scar tissue forms around a nerve after surgery. The scar tissue constricts the nerve which reduces the transport of critical chemicals that the nerve needs to stay healthy.

A nerve can also be damaged by killing some or all of its fibers. The image below shows that a nerve is made up of bundles of neurons (nerve cells) called fascicles. Groups of these fascicles make up the bigger nerve (4). In addition, the nerve is surrounded by a fatty sheath (myelin) that acts like an insulator covering a wire. When this sheath gets damaged there can also be a problem with nerve function.

Causes of Nerve Damage After Surgery and How to Treat It - Regenexx (1)

Alila Medical Media/Shutterstock

There are three types of nerve damage:

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  • Neurapraxia: damage to the covering of the wire, or myelin sheath
  • Axonotmesis: damage to the wire itself, or the neurons
  • Neurotmesis: the nerve is torn or cut in half

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How Common Is Nerve Damage After Surgery?

Somewhere between 0.5% and 2% of patients will have permanent nerve damage after surgery. Temporary nerve injury is much more common, especially in spine surgeries. See below for the nerve-related side effects of several common procedures:

  • Hip replacement: 0.2% to 0.6% (5)
  • Low back fusion surgery (transient nerve injury lasting less than three months): 50% to 62% (2,3)
  • Shoulder replacement surgery: 21% had temporary nerve damage, 2% had permanent nerve damage (6)

What Tests Show Nerve Damage?

There are a few tests to consider if you or your doctor suspect nerve damage after surgery:

EMG/nerve conduction study

This is an electrical test of the nerve’s function. One issue is that it is highly specific but has low sensitivity. This means that it will usually only pick up nerve damage that is more severe (7).

Ultrasound imaging of the nerve

This test can determine if the nerve size shows swelling and/or constriction. It works about as well as a nerve conduction study and is less invasive (8).

MR neurography

This is a very specialized MRI scan that’s tuned to show the nerves (9).

How Long Does It Take for Nerves to Repair After Surgery?

Most episodes of nerve damage after surgery last for a few weeks to a few months. If they last longer, then the rate of nerve regrowth is about an inch a month. Therefore, if the nerve is able to regrow, a nerve injury in the back could take years to regenerate the entire nerve from your back to your foot (10). However, many times scarring in or around the nerve prevents regrowth (11).

Learn about Regenexx procedures for spine conditions.

What Helps With Nerve Pain After Surgery?

Treatment options for nerve damage and pain after surgery include:

  • Orthobiologics (e.g. platelet-rich plasma — PRP)
  • Physical therapy may help.
  • Medications that are commonly used to treat nerve damage after surgery include:
    • Neurontin (Gabapentin) (12)
    • Lyrica (Pregabalin) (13)
    • Elavil (Amitriptyline) (14)
    • Topomax (Topiramate) (15)
    • Ultram (Tramadol) (15)

Ultrasound-Guided Nerve Hydrodissection With Orthobiologics

How can you break up scar tissue around nerves? Obviously, since the scar tissue was caused by surgery, using surgery to get rid of it can be a problem. However, there’s a new way to help nerves heal and get rid of the scar tissue called ultrasound-guided nerve hydrodissection with orthobiologics. In this procedure, a nerve is visualized with ultrasound. This is used to guide a small needle to inject fluid around the nerve to break up the scar tissue.

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In this procedure, which builds off our published work on treating spinal nerves with platelets, we inject the patient’s own platelet-derived growth factors that can assist nerve repair through cytokines like NGF, PDGF, and IG-1 (17,18). To see how this works on the median nerve in the carpal tunnel, see the video that follows.

Does this work? I cover two cases below.

Tanya’s Story

Tanya had a plastic surgery procedure on her gluteal area and ended up with a severe infection that caused scarring around the sciatic nerve. This basically gave her a dead leg. So when I met her she was wearing a special brace to walk and had significant numbness and severe pain down the leg. She could barely go up or down a flight of stairs. I performed the ultrasound-guided nerve hydrodissection with orthobiologics procedure a total of four times over the course of a year. I treated the entire length of the nerve, starting in the low back using fluoroscopy guidance, then turning to ultrasound-guided injections to treat the sciatic nerve down to the tibial and peroneal branches in the leg and foot. Where is she today? She no longer wears the brace, has gotten sensation back, and has limited pain. She does 30-inch box jumps in CrossFit and is planning on competing in a bodybuilding competition!

>> Find out how Tanya is doing in 2021.

Ivy’s Story

Ivy had a bad IV stick in her hand during which they injured the cutaneous branch of the ulnar nerve. Regrettably, she developed complex regional pain syndrome (CRPS) type 2 with pain so severe that she couldn’t have anyone touch the hand most days. This made it very difficult to work with kids as a nurse practitioner, as they often grabbed that hypersensitive hand.

I performed the ultrasound-guided nerve hydrodissection with orthobiologics procedure a total of four times over about a year, injecting all around the nerves in the hand, the ulnar nerve at the wrist and elbow, and the nerves in the neck. Her grip strength went from negligible to normal. Today she has very little pain most days and can see kids without a problem. This is especially remarkable because there are so few treatment options for patients once severe CRPS sets in.

The upshot? Nerve damage after surgery that doesn’t go away after a few months can be devastating. However, newer nonsurgical nerve repair techniques may be able to help.

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References

(1) Tos P, Crosio A, Pugliese P, Adani R, Toia F, Artiaco S. Painful scar neuropathy: principles of diagnosis and treatment. Plast Aesthet Res. 2015;2:156-64. doi:10.4103/2347-9264.160878

(2) Liang JQ, Chen C, Zhao H. Revision Surgery after Percutaneous Endoscopic Transforaminal Discectomy Compared with Primary Open Surgery for Symptomatic Lumbar Degenerative Disease.Orthop Surg. 2019;11(4):620–627. doi:10.1111/os.12507

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(3) Mueller K, McGowan J, Kane S, Voyadzis JM. Evaluation of retraction time as a predictor of postoperative motor dysfunction after minimally invasive transpsoas interbody fusion at L4-L5. J Clin Neurosci. 2019 Mar;61:124-129. doi:10.1016/j.jocn.2018.10.108

(4) King R. Microscopic anatomy: normal structure. Handb Clin Neurol. 2013;115:7-27. doi:10.1016/B978-0-444-52902-2.00002-3

(5) Fleischman AN, Rothman RH, Parvizi J. Femoral Nerve Palsy Following Total Hip Arthroplasty: Incidence and Course of Recovery. J Arthroplasty. 2018 Apr;33(4):1194-1199. doi:10.1016/j.arth.2017.10.050

(6) Lädermann A, Lübbeke A, Mélis B, Stern R, Christofilopoulos P, Bacle G, Walch G. Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am. 2011 Jul 20;93(14):1288-93. doi:10.2106/JBJS.J.00369

(7) Khambati FA, Shetty VP, Ghate SD, Capadia GD. Sensitivity and specificity of nerve palpation, monofilament testing and voluntary muscle testing in detecting peripheral nerve abnormality, using nerve conduction studies as gold standard; a study in 357 patients. Lepr Rev. 2009 Mar;80(1):34-50. https://www.ncbi.nlm.nih.gov/pubmed/19472851

(8) Emril DR, Zakaria I, Amrya M. Agreement Between High-Resolution Ultrasound and Electro-Physiological Examinations for Diagnosis of Carpal Tunnel Syndrome in the Indonesian Population. Front Neurol. 2019;10:888. doi:10.3389/fneur.2019.00888

(9) Schwarz D, Kele H, Kronlage M, Godel T, Hilgenfeld T, Bendszus M, Bäumer P. Diagnostic Value of Magnetic Resonance Neurography in Cervical Radiculopathy: Plexus Patterns and Peripheral Nerve Lesions. Invest Radiol. 2018 Mar;53(3):158-166. doi:10.1097/RLI.0000000000000422

(10) Recknor JB, Mallapragada SK. Nerve Regeneration: Tissue Engineering Strategies. In Bronzino JD (ed.). The biomedical engineering handbook (third ed.). Boca Raton, Fla.: CRC Taylor & Francis.

(11) Zhang H, Uchimura K, Kadomatsu K (November 2006). Brain keratan sulfate and glial scar formation. Ann N Y Acad Sci. 1086(1):81–90. doi:10.1196/annals.1377.014

(12) Griggs RB, Bardo MT, Taylor BK. Gabapentin alleviates affective pain after traumatic nerve injury. Neuroreport. 2015;26(9):522–527. doi:10.1097/WNR.0000000000000382

(13) Khan J, Noboru N, Imamura Y, Eliav E. Effect of Pregabalin and Diclofenac on tactile allodynia, mechanical hyperalgesia and pro inflammatory cytokine levels (IL-6, IL-1β) induced by chronic constriction injury of the infraorbital nerve in rats. Cytokine. 2018 Apr;104:124-129. doi:10.1016/j.cyto.2017.10.003

(14) Matsuoka H, Suto T, Saito S, Obata H. Amitriptyline, but Not Pregabalin, Reverses the Attenuation of Noxious Stimulus-Induced Analgesia After Nerve Injury in Rats. Anesth Analg. 2016 Aug;123(2):504-10. doi:10.1213/ANE.0000000000001301

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(15) Codd EE, Martinez RP, Molino L, Rogers KE, Stone DJ, Tallarida RJ. Tramadol and several anticonvulsants synergize in attenuating nerve injury-induced allodynia.Pain. 2008;134(3):254-262. doi:10.1016/j.pain.2007.04.019

(16) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. doi:10.1186/s40634-017-0113-5

(17) Sowa Y, Kishida T, Tomita K, Adachi T, Numajiri T, Mazda O. Involvement of PDGF-BB and IGF-1 in activation of human Schwann cells by platelet-rich plasma. Plast Reconstr Surg. 2019 Aug 27. doi:10.1097/PRS.0000000000006266

(18) Sánchez M, Anitua E2, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opin Biol Ther. 2017 Feb;17(2):197-212. doi:10.1080/14712598.2017.1259409

Causes of Nerve Damage After Surgery and How to Treat It - Regenexx (2)

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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FAQs

How do you reverse nerve damage after surgery? ›

Sometimes a section of a nerve is cut completely or damaged beyond repair. Your surgeon can remove the damaged section and reconnect healthy nerve ends (nerve repair) or implant a piece of nerve from another part of your body (nerve graft). These procedures can help your nerves regrow.

How do you heal nerve damage? ›

How Are Nerve Pain and Nerve Damage Treated?
  1. Regulating blood sugar levels for people with diabetes.
  2. Correcting nutritional deficiencies.
  3. Changing medications when drugs are causing nerve damage.
  4. Physical therapy or surgery to address compression or trauma to nerves.
  5. Medications to treat autoimmune conditions.
Apr 15, 2022

Can nerves repair themselves after surgery? ›

Your nerves have an ability to heal and regenerate even once they have been damaged, assuming that they have been properly repaired.

What vitamins help with nerve damage? ›

B Vitamins

Vitamins B-1, B-6, and B-12 have been found to be especially beneficial for treating neuropathy. Vitamin B-1, also known as thiamine, helps to reduce pain and inflammation and vitamin B-6 preserves the covering on nerve endings.

What promotes nerve healing? ›

Magnesium promotes the regeneration of the peripheral nerve.

Which juice is good for nerves? ›

Berries, peaches, cherries, red grapes, oranges and watermelon, among others, are loaded with antioxidants, which help to decrease inflammation and reduce nerve damage. Plus, grapes, blueberries and cranberries have been found to be full of a powerful anti-inflammatory compound called resveratrol.

What stimulates nerve growth? ›

Antibodies that bind to myelin and nerve cells and protect nerves from damage and stimulate myelin regeneration have been identified. A recent study also has found that regeneration of the myelin sheath can be stimulated by small, folded DNA molecules (aptamers).

How long before nerve damage becomes permanent? ›

As a specialist in peripheral nerve surgery, Dr. Seruya wants his patients to know that after a period of 12-18 months nerve damage can become permanent.

Do damaged nerves ever heal? ›

If your nerve is bruised or traumatized but is not cut, it should recover over 6-12 weeks. A nerve that is cut will grow at 1mm per day, after about a 4 week period of 'rest' following your injury. Some people notice continued improvement over many months.

How do you help nerves heal faster? ›

Extra sleep and rest. Sleep is essential for a healing nerve. The body repairs itself during sleep, so giving it more time to do so may help reduce symptoms quicker. In many cases, resting the affected area and getting extra sleep is enough to allow the pinched nerve to heal on its own.

Does exercise help nerve damage? ›

Regular exercise can help to combat pain and improve your overall health. Being active can reduce your blood sugar, which, in turn, can reduce or slow down nerve damage. Exercise also increases blood flow to your arms and legs and reduces stress. These are all factors that help to reduce discomfort and pain.

Can vitamin B12 heal nerve damage? ›

Vitamin B12 Enhances Nerve Repair and Improves Functional Recovery After Traumatic Brain Injury by Inhibiting ER Stress-Induced Neuron Injury - PMC. The .

How much B12 should I take for nerve damage? ›

Although treatment regimens of B12 injections vary, some doctors recommend injections of 1,000 micrograms (mcg) of vitamin B12 daily for five days followed by the same amount given once a week for five weeks, and then a lifelong dose of one injection per month, containing 100 to 1,000 mcg of vitamin B12.

Can vitamin B12 reverse nerve damage? ›

Supplementation for vitamin B12 deficiency should be provided parenterally since poor oral absorption is usually the cause of the disease. Supplementation with vitamin B12 typically halts progression of the disease, but does not reverse it since much of the disability is secondary to the spinal cord pathology.

Is magnesium good for nerve damage? ›

The beneficial effects of magnesium treatment have also been demonstrated in patients suffering from neuropathic pain, such as in those with malignancy-related neurologic symptoms, postherpetic neuralgia, diabetic neuropathy, and chemotherapy-induced peripheral neuropathy.

Which protein is good for nerves? ›

According to the study, a protein called Nogo-66, present on cells in the brain and spinal cord, prevents nerve-cell regrowth after traumatic injury.

Does massage help nerve regeneration? ›

A massage helps to reduce effects of injury by relieving compression of nerves an encouraging repair of damaged nervous tissues to increase. Relief of compressed nerves and healing of damaged nervous tissues reduces negative sensations such as pins and needles and numbness to improve sensation.

Is banana good for nerves? ›

Nerves: Bananas are high in B vitamins, which help calm the nervous system. PMS: The vitamin B6 that bananas contain regulates blood glucose levels, which can affect your mood.

What foods help nerves heal? ›

Omega-3–rich foods.

Fish oil has been found to restore the condition of damaged nerves due to the omega-3 found in it. Omega-3 foods such as salmon, tuna, cod, herring, sardines, mackerel, flaxseeds, and chia seeds help improve blood sugar regulation and control inflammation.

Does drinking water help neuropathy? ›

Drink lots of water

Water should be a staple in any diet, and even more so for those looking to reduce nerve pain. It's critical to stay hydrated throughout the day to reduce inflammation and avoid triggering pain receptors.

How much magnesium should I take for nerve damage? ›

If you have pain, a dose of 250 to 500 mg of magnesium a day can start to decrease these deficiencies as well as the pain, after just several weeks — while also leaving you feeling more energetic and decreasing your risk of heart disease!

What are the first signs of nerve damage? ›

10 Signs You May Be Suffering from Nerve Pain
  • Numbness or tingling in feet and hands.
  • Loss of balance and falling.
  • Throbbing and sharp pain.
  • Extreme sensitivity to touch.
  • Dropping things with your hands.
  • Muscle weakness.
  • Heavy feeling in arms and legs.
  • Dramatic drop in blood pressure.
Mar 21, 2017

What test shows nerve damage? ›

A nerve conduction velocity (NCV) test — also called a nerve conduction study (NCS) — measures how fast an electrical impulse moves through your nerve. NCV can identify nerve damage. During the test, your nerve is stimulated, usually with electrode patches attached to your skin.

What cream is good for nerve pain? ›

Nervive Pain Relieving Cream is formulated with maximum strength levels of Lidocaine HCL and Menthol to block nerve pain signals. Feel the non-greasy pain relieving cream start working in less than 5 minutes.

Is heat or cold better for nerve damage? ›

Nerve Pain

It's best to use cold when the pain is still sharp and move on to heat once that sharpness has subsided. The heat will increase blood flow and help tissues heal faster.

Is milk good for nerve damage? ›

Your nerves won't function properly without this protection. Food sources of vitamin B12 include fish, meat, poultry, eggs, and milk and other types of dairy. Your doctor or dietitian may also recommend oral or injectable supplements of vitamin B12.

Is nerve damage from surgery permanent? ›

According to one study, up to 2% of all surgical patients will suffer permanent nerve injury. Others might suffer temporary nerve damage which can nevertheless be corrected with surgery or allowed to heal on its own as the nerves regrow.

How long does nerve damage take to heal after surgery? ›

Successful nerve growth to the neuromuscular endplate may take as long as 6-12 months after surgery. After this period, nerve maturation and initial muscle recovery may take 12-18 months. Remember our body is hard at work healing before any electrical recovery can even be detected in the growing nerve fibers!

How long does nerve damage last after surgery? ›

If your nerve is bruised or traumatized but is not cut, it should recover over 6-12 weeks. A nerve that is cut will grow at 1mm per day, after about a 4 week period of 'rest' following your injury. Some people notice continued improvement over many months.

What helps nerves heal faster at home? ›

Green and leafy vegetables. Broccoli, spinach and asparagus all contain vitamin B, a nutrient important for nerve regeneration and nerve function. Spinach, broccoli and kale also contain a micronutrient called alpha-lipoic acid that prevents nerve damage and improves nerve function.

What happens if you get nerve damage from surgery? ›

Numbness – if a nerve that transmits feeling is injured, you may experience a loss of sensation. Weakness – if a nerve in charge of mobility is injured, you may experience weakness. Pain– pain is a common symptom of nerve injuries, especially tingling or burning sensations.

How do I know if nerve damage is permanent? ›

As a specialist in peripheral nerve surgery, Dr. Seruya wants his patients to know that after a period of 12-18 months nerve damage can become permanent.
...
Sensory nerve damage symptoms:
  1. Pain.
  2. Sensitivity.
  3. Numbness.
  4. Tingling.
  5. Prickling.
  6. Burning.
  7. Problems with positional awareness.
Feb 15, 2019

Does exercise help nerve damage? ›

Regular exercise can help to combat pain and improve your overall health. Being active can reduce your blood sugar, which, in turn, can reduce or slow down nerve damage. Exercise also increases blood flow to your arms and legs and reduces stress. These are all factors that help to reduce discomfort and pain.

What natural remedy is good for nerve damage? ›

Walk it off. Exercise releases natural painkillers called endorphins. Exercise also promotes blood flow to the nerves in the legs and feet. Researchers believe that regular exercise may create a long-lasting expansion in blood vessels in the feet, nourishing damaged nerves back to health.

Does B12 help with nerve pain? ›

One proposed treatment for neuropathic pain is vitamin B12, which is thought to alleviate pain by a number of mechanisms including promoting myelination, increasing nerve regeneration and decreasing ectopic nerve firing.

Can you speed up nerve damage recovery? ›

Electrical stimulation a week before surgery causes nerves to regenerate three to five times faster, leading to better outcomes. Summary: Researchers have found a treatment that increases the speed of nerve regeneration by three to five times, leading to much better outcomes for trauma surgery patients.

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