Neuroplasty; nerve of hand or foot
CPT4 code
Name of the Procedure:
Neuroplasty; Nerve of Hand or Foot
Common name(s): Neurolysis, Nerve decompression
Technical/Medical terms: Peripheral nerve neuroplasty
Summary
Neuroplasty is a surgical procedure aimed at relieving compression or entrapment of nerves in the hand or foot. This procedure involves freeing the nerve from surrounding scar tissue or structural obstructions to restore normal nerve function and alleviate pain.
Purpose
Medical Condition/Problem: Neuroplasty addresses nerve compression or entrapment, which can cause pain, tingling, numbness, weakness, or impaired movement.
Goals/Expected Outcomes: The primary goal of neuroplasty is to relieve symptoms by decompressing the affected nerve, thereby improving the patient's quality of life and restoring hand or foot function.
Indications
Specific Symptoms/Conditions:
- Persistent pain, numbness, or tingling in the hand or foot.
- Weakness or loss of function in the hand or foot due to nerve compression.
- Diagnosed conditions such as carpal tunnel syndrome, tarsal tunnel syndrome, or other localized nerve entrapments.
Patient Criteria:
- Failure of conservative treatments such as physical therapy, medications, or splinting.
- Clinical and diagnostic evidence of nerve compression or entrapment.
Preparation
Pre-Procedure Instructions:
- Fasting is usually required 6-8 hours before the procedure.
- Patients may need to discontinue certain medications (e.g., blood thinners) as directed by their healthcare provider.
- Pre-procedure diagnostic tests, such as nerve conduction studies or imaging (MRI, ultrasound), may be required for precise localization of nerve entrapment.
Procedure Description
Step-by-Step Explanation:
- The patient is positioned and prepped under sterile conditions.
- Anesthesia, typically local with sedation or general anesthesia, is administered.
- A small incision is made near the affected nerve.
- The surgeon carefully dissects through soft tissues to expose the compressed nerve.
- Scar tissue or obstructions compressing the nerve are removed or released.
- The nerve is carefully inspected to ensure it is free from entrapment.
- The incision is closed with sutures, and a sterile dressing is applied.
Tools/Equipment: Surgical instruments such as scalpels, forceps, and retractors.
Anesthesia/Sedation: Local anesthesia with sedation or general anesthesia, depending on the case and patient preference.
Duration
The procedure typically takes between 1 to 2 hours, depending on the complexity and specific location of the nerve involved.
Setting
Neuroplasty is usually performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Orthopedic or plastic surgeon specializing in hand or foot surgery.
- Anesthesiologist or nurse anesthetist.
- Surgical nurses and technicians.
Risks and Complications
Common Risks:
- Infection at the surgical site.
- Bleeding or hematoma formation.
- Nerve damage or incomplete relief of symptoms.
Rare Complications:
- Chronic pain or complex regional pain syndrome (CRPS).
- Recurrence of nerve entrapment symptoms.
Management: Immediate medical attention for any unusual symptoms post-surgery, such as severe pain, swelling, or signs of infection.
Benefits
Expected Benefits:
- Relief of pain and other symptoms related to nerve entrapment.
- Improved function and mobility of the hand or foot.
- Enhanced quality of life.
Realization Time: Some patients experience immediate relief, but full recovery and symptom resolution can take several weeks.
Recovery
Post-Procedure Care:
- Keeping the surgical site clean and dry.
- Following instructions on wound care and activity restrictions.
- Pain management with prescribed medications.
Expected Recovery Time: Full recovery may take 4-6 weeks, with gradual resumption of normal activities. Physical therapy may be recommended.
Follow-Up: Regular follow-up appointments to monitor healing and nerve function.
Alternatives
Other Treatment Options:
- Conservative treatments such as medications, physical therapy, splinting, or corticosteroid injections.
- Minimally invasive procedures, depending on the specific condition and severity.
Pros and Cons Comparison: Conservative treatments are less invasive but may be less effective for severe cases. Neuroplasty offers a direct approach to resolving the nerve entrapment but carries surgical risks.
Patient Experience
During the Procedure:
Under local anesthesia with sedation or general anesthesia, the patient may be awake but will not feel pain.
After the Procedure:
- Some pain and discomfort are expected, manageable with prescribed medications.
- Swelling and bruising around the surgical site are common but typically subside within a few days.
- Physical therapy may be recommended to enhance recovery and restore function.