For surgical nerve injuries, waiting for them to heal on their own can be dangerous

 

Some nerve injuries have a narrow time window for surgical correction

 
January 11, 2018

A patient recently called our office about a nerve injury that happened during a hernia repair surgery at a hospital in Houston's Texas Medical Center.

As soon as this young lady woke up from surgery, she felt pain in her abdomen (stomach) area that extended to her leg. She went to follow-up appointments with her surgeon for several months, and was told just to give it time and it would heal. Eventually, though, the surgeon concluded that he must have accidentally cut or severed a nerve.

The surgeon recommended a nerve block and referred her to a pain specialist for long-term management. She has now had several nerve block infections, which have provided temporary relief for her severe, disabling nerve pain.

Now, almost two years later, she learned from her pain management doctor that her nerve injury is permanent. Her options are to continue with pain management, learn to live with it, or have a back surgery to remove the damaged nerve. With the surgical option, she will have constant numbness down her leg for the rest of her life.

As a Houston, Texas medical malpractice lawyer, I have handled many cases where patients experienced permanent nerve injuries from various kinds of surgeries. In addition to the hernia surgery I just discussed, some other examples come to mind.

When patients have thyroid surgery, the recurrent laryngeal nerve is at risk.

In general surgeries to remove benign or fatty tumors in the arms, the median, radial, or ulnar nerves can be cut, nicked, or severed.

Any type of surgery that involves general anesthesia (having the patient asleep) poses a risk of positioning nerve injuries. The standard of care requires the anesthesiologist and nursing staff to use pads, pillows, and certain positioning to prevent compression of the ulnar nerve, for instance, during surgery.

Categories and timing in surgical nerve injuries

Nerve injuries are notoriously slow to heal, if they heal at all. Experts classify nerve injuries in six different categories, or degrees. The higher the degree, the more severe the damage and more questionable the ability to fix or heal it.

A first degree nerve injury is called neurapraxia, which typically will fully heal, without treatment, within days to three months of the surgical injury.

A second degree nerve injury is referred to as axonotmesis. These injuries are expected to fully recovery, without treatment, with a rate of recovery of one inch (1”) of nerve per month.

Beginning with a third degree nerve injury, recovery becomes more uncertain. There may be partial spontaneous recovery, at a rate of recovery of one inch (1”) of nerve per month. Neurolysis (a neurolytic block) may be a necessary treatment.

For a fourth degree nerve injury, no recovery is expected without a surgical treatment such as nerve repair, graft, or transfer.

A fifth degree nerve injury is called neurotmesis, which is also treated with surgical treatment such as nerve repair, graft, or transfer.

The final category, a sixth degree nerve injury, is considered a mixed injury. The recovery and type of surgical treatment varies, depending on the type and combination of nerve injury.

While lower degree nerve injuries may heal on their own, the more severe ones require surgery to fix the problem. Nerve repair surgery experts have found that better results occur when surgery is done sooner rather than later.

Unfortunately, in my experience, many surgeons initially jump to the conclusion that the injury will heal on its own and recommend that their nerve injury patients take a “wait and see” approach. During this time period, patients are losing precious time when their injury might be able to be repaired. Sometimes the delay in treatment is so long that the injury becomes permanent.

We are here to help

Some surgeons cause a nerve injury and then make matters worse by not recommending corrective treatment. If you or a loved one has been seriously injured as a result of surgical or medical malpractice, call Painter Law Firm, at 281-580-8800, for a free consultation about your potential case.

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Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He files medical malpractice and wrongful death lawsuits on behalf of patients and family members against hospitals, surgeons, doctors, anesthesiologists, and other healthcare providers. Since 2011, he has been recognized by  Martindale-Hubbell with its highest level designation, an AV rating, for legal ability and ethics. He frequently speaks and writes about healthcare topics and medical malpractice. He is a past editor-in-chief of The Houston Lawyer magazine and is currently on the editorial board of the Texas Bar Journal.

Robert Painter

Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.

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