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surgery to remove affected nerves

Posted by christine on April 29, 1999 at 09:48:51
Back in 1997, I had an accident at work which affected my right knee. After two or three surgeries, the original problem was resolved, but I was left with neuropathy of the saphenous nerve.  The nerve specialist removed this nerve, and the relief was wonderful.  the burning and electrical shocks were gone.  Unfortunately it turns out that now my sural,tibial,and sciatic nerves are also affected.  The surgeon has suggested removing the sural nerve, but warned me of complictions.  i am afraid that these nerves all run together and I dont know how handicapped I will be left.  PLEASE respond, I am to meet with the surgeons next week, and will have to give an answer.  I want the neuorpathy pain to stop, and I already have atrophy in my leg.  Is this a wise thing to do in your opinion? Thank you so very much. This will be my seventh surgery in less than 2 years on the same knee, and I am a bit worried about having another.  Christine

Posted by CCF MD GS on April 29, 1999 at 10:04:46
Thanks for the question and I'm sorry to hear about your problems. I guess I'm not sure what you mean by telling me that your sural, sciatic and tibial nerves are now affected. I'm not sure what that means. As you know nerves have motor or sensory function and destruction of a nerve can result in sensory loss or loss of motor fuction. The sural nerve is a common nerve to biopsy in certain clinical setting and patients usually just have numbness in the distribution of the nerve but some patient will end up with pain syndromes afterwards. I'm not sure why they want to remove the sural nerve. The fact that you have atrophy in your leg suggests either disuse or nerve injury. The whole story seems alittle odd to me and I think you need to be evaluated by a neurologist specializing in peripheral nerve injuries before you go any further. You also need an EMG performed at a lab used to treating the types of problems you are currently having. If possible I would recommend a consult at CCF. You can call 216 444 5559 to set an appointment. It makes me nervous to think that you will have more nerves cut out since the affeects can be permenant. Good luck
This information is provided for general medical education purposes only. Please consult your doctor regarding diagnostic and treatment options.

Posted by christine on April 29, 1999 at 10:42:03
I am sorry if I confused you, but I was trying to be as brief as possible.  the nerve damage was caused while orthopedic sugereons removed a bothersome hamstring.  i started having neuropathic pain and symptoms shortly after, and it was concluded that these nerves I mentioned were"stretched" beyond their capabilities.  Had emg testing and was told that these nerves were severly damaged, beyond spontaneous repair.  In other words, have to live with it.  No meds were even slightly helpful, and the pain was excrutiating.  the neurosurgeon went back in, and removed my saphenous nerve, but we have since learned that other nerves are injured as well.  Now i am left with the choice of removing these nerves as well, so I am debating which is worse, the constant pain, or the numbness after .  i was also informed that the tibial nerve has a great deal to do with the flexor motion of the foot, and I could lose this motor ability, depending on what they find when they go in.  I need to know if removing the sural nerve will in fact cause any effect on the tibial nerve, sciatic nerve, and the peronal nerve.  it was suggested by my doctors that removal of the sural nerve could affect the surrounding motor functions.  I am sorry if I concused you, and thank you so much for responding so quickly!!

Posted by CCF MD GS on April 29, 1999 at 11:21:23
Thanks for the update. I think in genral we like to preserve nerve function as much as possible since there is usually no going back once things are removed. Nerves do have some capacity to regenerate and at times nerve grafting can be helpful. It is a complicated case and one that is difficult to give information on over the internet. I'm not exactly sure why taking the sural nerve should affect the other nerves but it may be related to where they are considering removing the nerve. I guess all I can tell you is to examine your options and if you have not done so see a peripheral nerve expert. Dr. Klien in Louisiana (I think New Orleans but you can check with your doctor) probably has the most experience with these types of problems. I explore all your options prior to having further surgery. Good luck
Posted by christine on April 29, 1999 at 12:07:09
Thanks so much for all of your helpful info.  I am so glad I found this sight, and i hate to bother you with another question, but I can never get anwers when i call the neurosurgeons office, and info on the internet is so limited.  In the place where I have atrophy, inside of knee, due to nerve injury and missing hamstring, my physical therapist has noticed a constant "firing" up of the muscles making my calf "twitch".  could this be due to motor function deficet?  Or is a guarding habit? I do not feel it or notice it . It seems to happen after a mild workout, or walking too much.  Wonder if it is related to the sural nerve injury?  I promise this is the last question I will submit! I know plenty of other people need your advice. As for the rareity of this case, It is the first time any of the surgeons i deal with have ever seen it, and any disease has been rule out.  It is all because of nerve damage in the surgical site.   We are all at a loss as to how to treat it, so we take it one step at at time.  I think this case is for the books!!! Thanks again,

Posted by CCF MD GS on April 30, 1999 at 08:32:40
The twitching you are talking about probably is a fasciculation which is a spontaneous discharge in your case from injured lower motor neurons. Everyone can get these at some time and they can be benign but they again represent nerve injury in your case. It in itself means nothing worse is going on. It probably has nothing to do with the sural nerve. Again I think this is a case that a peripheral nerve specialist should look at before any further surgery is suggested. An MRI of the leg could also help identify muscles injured. Good luck

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