​ Surgery

Turning the Table

Advancements in nerve repair saved surgical career

By Patrick H. Smock, MD

atients undergo surgical procedures to repair peripheral nerve injuries every day. Most of the time I am the one in scrubs performing the procedure to restore a patient’s ability to move, feel or to even eliminate pain as the result of a nerve injury. Recently, after suffering a minor yet career-impacting injury, I found myself on the other side of the operating table.

As an orthopedic surgeon with a specialization in hand, and upper extremity injuries, I am well-acquainted with the intricacies of the nearby nervous system. However, I never considered how a nerve injury would impact my ability to perform surgery or how a procedure I frequently perform truly affects quality of life, for both myself and my patients.

I’ve now had the unique experience as both the surgeon and the patient and the benefit of being on the receiving end of advancements in nerve repair. It has granted me a renewed perspective on my decision to become a surgeon. I hope that my story will help fellow health care professionals to fully understand options when dealing with nerve injuries after a traumatic injury —or a minor injury that has major repercussions, like mine.

My Story

Back in 2014, I was in a mountain bike race and suffered a fairly common injury, called a skier’s thumb. I made an abrupt stop and consequently dislocated my thumb and tore a nearby ligament. Believing that I was dealing with instability in my thumb alone, I quickly sought surgery to repair the ligament damage and put the whole experience behind me.

​I found myself on the other side of the operating table.

As my recovery progressed, I started to notice loss of sensation in my thumb and forefinger and also began to develop significant pain in that region of my hand. It quickly became evident that I had also sustained nerve damage in the accident, something I often see in my own practice.

As a surgeon, I rely on proper dexterity and feeling in my fingers and began to worry about the implications this impairment could potentially have on my profession. I found myself in a situation I had never before considered: the permanent loss of feeling in one of my fingers.

Fortunately, I understood the importance of seeking treatment in a timely manner and quickly connected with a friend, fellow surgeon and former colleague who helped determine that a neuroma, a painful tangle of broken and damaged nerve fibers, had developed in my radial sensory nerve due to the accident months prior, but had only recently started to cause concerning symptoms. I had surgery to remove the neuroma, and my surgeon used an Avance® Nerve Graft, a human nerve allograft, to bridge the nerve gap and allow it to regrow. Within a few months, I had regained all sensation in my fingers and the pain had dissipated.

Because of this procedure, I was able to achieve a positive outcome and was back to operating with an increased appreciation for the impact a nerve injury can have on a patient’s life.

As a father of five, I strive to remain as healthy as possible, and while this was a minor injury, there was never a doubt that it needed to be corrected, for my family and for my career.

Recognizing and Repairing Damaged Nerves

Patients who have suffered a nerve injury often land in a primary care physician’s office seeking help for their symptoms. It’s important for primary care physicians to have a working understanding of nerve damage and be able to recognize the symptoms so they can quickly direct their patients to a nerve specialist who can help.

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Nerves can commonly be injured as the result of falls, fractures, glass or knife cuts, car accidents where limbs are stretched or badly bruised, gun shots, or even overuse injuries like carpal tunnel syndrome. It’s also possible that a nerve may have been unintentionally damaged during a previous surgery and the patient later develops nerve damage related symptoms.

In addition to a loss of sensation or inability to move an area of the body, patients with nerve damage may complain of chronic pain, sharp spasms, burning sensations, or extreme sensitivity to touch and temperature.

Chronic pain is particularly important to keep in mind. Often, the first course of treatment for patients with chronic pain is to manage the symptom through pain medication or noninvasive treatments such as massage treatments, acupuncture and physical therapy. Many of these treatments offer temporary relief, but do not fix the source of the pain which could be an injured nerve. If a patient’s pain lasts greater than three months after an injury or surgery, there is a chance it may be due to a nerve injury and should be further evaluated by a physician specializing in nerve repair.

Timing is also essential – damaged nerves can be surgically repaired, but the window of time for the best surgical outcome is limited. Patients with potential nerve damage should be sent to a nerve specialist as quickly as possible after injury.

Advancements in Nerve Repair

It’s also important to understand what nerve repair can look like for our patients. For me, as both a nerve surgeon and a patient, the advancements in nerve repair have been particularly interesting as I personally benefited from an emerging technology that helped to improve my recovery.

In the past, one of the only options for nerve repair was to harvest a nerve from another site on the patient’s body—typically the leg in order to repair the injury. This procedure caused a patient to have two surgical sites in addition to often permanent and bothersome numbness at the harvest site.

Today there is another option. Axogen, a pioneer in peripheral nerve repair,  has developed  the Avance® Nerve Graft which offers clearly documented improvements in the way nerves are repaired and eliminates the potential comorbidities associated with a second surgical site.

​Many chronic pain  patients may not realize a neuroma is causing the issue.

Avance Nerve Graft has since been widely used to help surgeons successfully repair damaged and injured peripheral nerves across the body. There are over 100 published clinical papers describing the use of Avance® Nerve Graft for the repair of sensory and motor nerves in the hands, arms, face, torso and lower extremities.

Moving Forward

While I was aware of these medical advances prior to my injury, I have become more of an advocate for the technology ever since, using it frequently when working with patients suffering from nerve damage. I recommend the same procedure I had done and the same technology that helps me do my job to patients with similar or even much more severe injuries than myself. My goal is to help patients return to normal life as soon as possible.

I find this particularly valuable when it comes to my patients who are suffering from pain. While I was able to connect my nerve pain to my traumatic injury relatively easily, many chronic pain patients may not realize a neuroma is causing the issue and that it’s something  that can be surgically repaired. It’s important to know that if a patient’s pain is still present three months after a traumatic injury or a surgery, there is a good chance a nerve injury may be to blame and they should be evaluated by a nerve specialist like myself. If a neuroma is the cause of the pain, through surgical nerve repair, patients have an opportunity to live pain free and resume a more normal life, and we should do everything our power to give that to them.

Nerve damage, however small the originating injury, can cause excruciating pain, put lives on hold and jobs at risk when not addressed properly  in a timely manner. I stress the importance of nerve repair procedures to my patients daily.

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My job is dependent on the proper function of my hands. You don’t truly realize the importance of the ability to use your hands until you lose it.  Had I not recognized the cause of the pain and numbness as a nerve injury and sought care in a timely manner, my situation could have become more permanent.

Fortunately, nerve repair technologies are widely studied, and we now have groundbreaking options to help ensure these injuries are temporary. My experience on the operating table heightened my passion for my career choice and supplemented my goal to provide my patients the best options for their recovery.

Patrick H. Smock, MD, is an orthopedic surgeon specializing in hand, wrist and elbow injuries at Allina Health Orthopedics in St. Paul, MN.