Dr. Tollestrup explains why an orthopedic surgeon who is not trained to perform peripheral nerve surgery nor knowledgeable about the peripheral nerve anatomy can cause further damage for the patient already suffering from nerve pain. Often after the orthopedic surgery the patient is in worse condition and the surgeon is unable to troubleshoot the problem. This leaves both patient and doctor frustrated and unsure of how to proceed. Dr. Tollestrup has a solution. Take a listen.
One issue that I come across a lot is patients that have gone to let’s say a neurosurgeon, or an orthopedic surgeon, to have a specific peripheral nerve problem addressed. The problem with that is that these types of surgeons are not trained in peripheral nerve surgery more widely. Probably the best example I can think of this is piriformis syndrome, which is compression of the sciatic nerve by the piriformis muscle.
This is sort of an additional thing that they’ve learned to do because they read about it in a medical journal somewhere. I do endoscopic surgery on the hip, so I can do an endoscopic piriformis release, that kind of thinking. When you have somebody that only has a hammer, everything starts to look like a nail. But when this piriformis muscle is released, what happens is the tendonous part, you can see how it’s wrapped right around, kind of curls right underneath the sciatic nerve and just strangulate the nerve.
This procedure to remove the piriformis muscle, you can see that the muscle is totally gone now. Even if I retract on this, you really can’t see it. You divide it way up there under a little bit of tension and it completely disappears. That’s where that nerve was compressed by the tendon really badly. See, it’s all nicely decompressed now.
Many times, especially in patients, who’ve had surgical procedures where the approach has been through the buttock, or they’ve had some kind of traumatic injury, a blunt trauma or penetrating trauma, there can be more than one nerve involved in the problem. If you have some procedure, but you don’t identify all the problems that are existing beforehand. The patient’s going to feel like they aren’t having a good outcome. The surgeon who only knows how to do an endoscopy piriformis release will have no idea how to investigate or figure out what else is going on.
And so it ends up being a frustrating situation for both surgeon and patient. Sometimes when you operate anywhere, you can damage nerves, especially when you don’t understand where these nerves are. So, if you’re just willy nilly, poking holes to put ports in to do an endoscopic release, or you make a big incision for an open release, there’s other nerves that can be damaged. And then post-operatively, these surgeons who don’t understand peripheral nerve anatomy very well, don’t really have any idea of what the problem is.
For patients who are really suffering with neurogenic pain, it is a good idea to be evaluated by somebody who specializes in the peripheral nervous system, and not by somebody who really hasn’t been trained in peripheral nerves at all.