Chronic Joint Pain

Whether the origin of pain is due to trauma, arthritis, or previous surgery on the joint, the final common pathway for the pain signal leaving the joint is through sensory nerves. These small sensory nerves exit the bone, cartilage, ligaments, and joint capsule to form larger nerves that carry the pain signal toward the spinal cord. Commonly, these small nerves are directly injured in a fall or indirectly from a previous operation on the joint that causes them to continually send pain signals.

Options for Joint Pain

The first step in evaluating chronic joint pain is to schedule an appointment with a medical or surgical specialist interested in Sports Medicine, Orthopedic Surgery, or Podiatric Foot and Ankle Surgery. They will examine your joint and possibly order and X-ray or MRI to ensure the joint is mechanically stable. Your doctor may order anti-inflammatory medications or recommend physical therapy. If your joint pain persists, a consultation with a pain management specialist may provide non-surgical options for pain relief.

Are there surgical options for my chronic joint pain?
If your joint is mechanically stable and your pain persists, you may be a candidate for partial joint denervation surgery at Florida Plastic Surgery Group. Partial joint denervation surgery is a surgical technique to disrupt only the damaged nerves carrying pain signals from the joint. Following partial joint denervation surgery, the body is able to sense the position, location, orientation, and movement of the body in relation to the joint. As the function of proprioception is not disrupted, there is no loss of motor function. Partial joint denervation surgery offers complete or near complete relief of your chronic joint pain. Oftentimes, range of motion improves as the pain signal is gone and activity levels can increase.

Which joints can be treated with partial joint denervation surgery?
The shoulder, elbow, wrist, knee, and ankle are commonly injured joints that may be surgically treated with partial joint denervation surgery.

The Process

Am I a candidate for partial joint denervation surgery?
After ensuring the joint is mechanically stable, your surgeon will perform a nerve block to identify the source of your joint pain. The nerve block is performed in the office setting, similar to a dental block performed by your dentist to alleviate your toothache. The nerve block targets the nerves surrounding the joint and does not involve an injection into the joint. If your pain is significantly relieved by the nerve block, then partial joint denervation surgery can be up to 90% successful.

I have chronic joint pain, what is the next step?
Prior to the initial consultation:

• Complete our chronic joint pain questionnaire
• Obtain your records from prior treating physicians outlining previous treatment or diagnostic studies pertinent to your chronic joint pain

What is done at the initial consultation?
The initial consultation steps:

• Our surgeons will review your history with you, perform a physical examination, and answer all your questions and concerns
• Our surgeons will perform a diagnostic nerve block to identify if your chronic joint pain is neural in origin and can be surgically treated

Surgery Expectations

Surgery is performed under general anesthesia under supervision of a board certified anesthesiologist.

For most patients, surgery is performed on an outpatient basis (you go home the same day). Depending on the number of nerves treated, surgery takes 1-2 hours to perform.

What should I expect during my partial joint denervation surgery recovery?
Following surgery until the first visit (usually 7 days), we encourage patients to relax, and not perform any strenuous activity. You can use your shoulder, elbow, wrist, knee and ankle immediately after surgery for gentle range of motion exercises. If the knee or ankle was operated on, we recommend elevation of the leg and the use of crutches or a walker during the first week following surgery. A dressing is placed over the incision(s) until it is removed during the follow up visit. Activity is gradually increased and most patients are back to work and normal activity within 1-2 weeks. We encourage an evaluation and treatment by a physical therapist to aid in range of motion and strengthening exercises of the surrounding muscles. Please note that you are not able to drive or operate heavy machinery while taking any postoperative narcotic pain medication.

Some patients experience immediate pain relief. However, in some cases, patients must wait several months for relief to take effect.

All sutures (except those used for the knee) are typically dissolvable and do not require removal.

What are the risks of partial joint denervation surgery?
In addition to common surgical risks, the unique risks of partial joint denervation surgery include: persistent join or limb pain; unpredictable scar formation; permanent numb areas of skin surrounding the joint if the nerves to the skin need to be removed in addition to the partial joint denervation; 5 to 10% of surgical candidates require a second surgery to remove an additional nerve causing persistent joint pain; underlying arthritis may continue; and if a joint has been replaced, there is the rare risk of either exposing the joint implant or an infection occurring around the implant that may necessitate its removal.

To learn more about chronic joint pain and how our plastic surgeons can help you relieve your pain, please contact our office today to schedule a consultation.