64783 Excision of neuroma; hand or foot, each additional nerve, except same digit (List separately in addition to code for primary procedure)

Name of the Procedure:

Excision of neuroma; hand or foot, each additional nerve, except same digit

Summary

This procedure involves the surgical removal of a neuroma— a painful, benign growth of nerve tissue— from either the hand or foot. It is performed to alleviate pain and restore normal nerve function.

Purpose

The procedure addresses the issue of neuromas, which can cause significant pain, tingling, or numbness. The ultimate goal is to eliminate the source of nerve pain and improve the patient’s quality of life.

Indications

• Persistent pain or discomfort in the hand or foot attributable to neuromas
• Numbness or tingling in the affected area
• Failure of conservative treatments like medications, physical therapy, or steroid injections
• Neuroma confirmed through diagnostic imaging or clinical examination

Preparation

• Patients may be asked to fast for a certain number of hours before the procedure.
• Adjustments to current medications, especially blood thinners, may be necessary.
• Pre-operative diagnostic tests such as MRI or ultrasound may be conducted to locate the neuroma accurately.

Procedure Description

1. Anesthesia: Local or general anesthesia will be administered based on the surgeon’s recommendation and patient’s condition.
2. Incision: A small incision is made over the area where the neuroma is located.
3. Excision: The surgeon carefully identifies and excises the neuroma, sparing as much healthy nerve tissue as possible.
4. Closure: The incision is closed with stitches, and the area is bandaged.

The procedure generally employs surgical instruments such as scalpels, forceps, and nerve hooks.

Duration

The procedure typically takes about 30 minutes to 1 hour, depending on the complexity and number of neuromas being removed.

Setting

The procedure is usually performed in an outpatient surgical center or a hospital operating room.

Personnel

• Surgeon specializing in hand or foot surgeries
• Surgical nurse
• Anesthesiologist (if general anesthesia is used)
• Surgical technician

Risks and Complications

• Infection at the incision site
• Bleeding
• Nerve damage or persistent numbness
• Scar tissue formation
• Recurrence of neuroma

Benefits

• Reduction or elimination of neuropathic pain
• Improved mobility and function of the hand or foot
• Enhanced quality of life

Recovery

• Patients usually go home the same day.
• Post-surgical pain and swelling are managed with medications and ice packs.
• Instructions may include keeping the incision site clean and dry, avoiding strenuous activities, and attending follow-up appointments.
• Full recovery typically takes a few weeks, but this can vary.

Alternatives

• Conservative treatments like physical therapy, orthotics, or pain medication
• Corticosteroid injections to reduce inflammation
• Radiofrequency ablation or cryotherapy
• Pros of alternatives: Less invasive, shorter recovery time.
• Cons: May not provide long-term relief, and symptoms could persist.

Patient Experience

During the procedure, patients under local anesthesia may feel pressure but not pain. Post-procedure, some discomfort and swelling are normal. Pain is generally manageable with prescribed medications. Full activity can usually be resumed within a few weeks, with specific restrictions advised by the surgeon.