Melbourne Hand Surgery 

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Latest news: Masks are mandatory when you attend our practice in person, and we request that you log your attendance via our Victorian Government QR code, by entering location code 3D7RE3 into the Services Victoria App or by writing your details on the physical register at our reception.

Elective surgeries are currently unrestricted and you do not need to have a COVID test prior to hospital admission for elective surgery if you have no COVID symptoms or other risk factors. Dr Tomlinson is operating at The Avenue and Glenferrie Private; Epworth Cliveden is indefinitely closed at this time. 

All suitable consultations at Melbourne Hand Surgery are currently conducted via telehealth at our dedicated virtual clinic to maximise patient and staff safety. We have implemented enhanced hygiene measures in our rooms including acrylic screens, masks, hand sanitiser, face shields and physical distancing-related changes. We require that all patients provide a referral prior to booking an appointment so that we can identify and manage urgent and emergency conditions in a timely manner, and so that our surgeons can assess your suitability for a telehealth appointment and identify any further information or tests that might be required before your consultation.

Peripheral nerve surgery for chronic pain

woman in rain yellow jacket handsPeripheral nerve surgery can relieve chronic pain in some patients. Broadly speaking, there are three instances where peripheral nerve surgery may be of benefit.

1. Nerve Compression

Firstly, when the chronic pain is caused by nerve compression. This includes the relatively common conditions of carpal tunnel syndrome and cubital tunnel syndrome. Nerve compression can develop for no particular reason but it can also be the result of trauma or surgery. Relief of this type of pain can be achieved by surgical decompression. For individuals who have nerve compression as a result of trauma or surgery, a good result from surgical decompression is most likely if the pain can be completely temporarily relieved by injection of local anaesthetic at the area of suspected compression.

2. Neuroma

Secondly, surgery may be of benefit when the chronic pain is caused by a neuroma. A neuroma can grow at the site of an injured nerve, and comprises regrowing nerve ends that form a little ball because they have nowhere to grow. A neuroma is often exquisitely tender to pressure. Removing the neuroma and placing the cut nerve end where it will be less likely to be subjected to pressure can be of great benefit to individuals who have chronic pain from a neuroma.

3. Denervation Surgery

man holding dumbellThirdly, surgery may be of benefit when the chronic pain affects a region of the body that can be denervated - where the nerves to the body region (often a joint) are severed. This treatment is only suitable in select cases. The treatment cannot be guaranteed and may not be permanent in all patients, as it is possible that a) not all the involved nerves will be able to be identified, and b) in some instances the nerves may regrow. Often numbness of the skin is a tradeoff of the surgery - while the cut nerve no longer transmits pain signals, it also does not transmit sensation signals.

Diagnosis

Nerve conduction studies can diagnose nerve compression and are recommended prior to decompression if there is any doubt or question about the diagnosis. If a neuroma is suspected your surgeon may conduct a diagnostic "test" where local anaesthetic is injected at the site of the suspected neuroma to see if this temporarily relieves your symptoms. This type of "test" may also be tried prior to denervation surgery.

References & further reading

 

FRACS

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