With a background that includes authoring numerous journal articles and textbook chapters on neuroma surgery, Dr. Chang’s approach is grounded in the latest research and techniques. His meticulous pre-operative assessments ensure that your unique condition is thoroughly evaluated, leading to a tailored surgical plan designed to achieve optimal pain relief and functional improvement. Trust in Dr. Chang’s expertise for a precise, effective solution that targets your pain and enhances your quality of life. 

Dr. Chang is a leading expert in peripheral nerve surgery, bringing elite skills and extensive knowledge to every neuroma treatment.

Neuroma surgery can improve the pain and discomfort caused by symptomatic neuromas that have developed after trauma, surgery, or amputations. This procedure aims to significantly reduce the severity and frequency of your pain, providing much-needed relief and improving your overall quality of life. By targeting the source of your discomfort, neuroma surgery can help restore function and ease the persistent pain that may be impacting your daily activities and overall well-being.

Overview & Why Choose Dr. Chang

Neuroma Surgery

  • Symptomatic Neuroma – A neuroma is a collection of scar tissue either at the end of or within a damaged peripheral nerve. Because the injured nerve is trying to fix itself, it continues to sprout nerve tissue that may become very sensitive and painful. While not all neuromas cause problems, symptomatic ones can significantly hinder one’s quality of life and functional capacities. Patients who have chronic pain from a symptomatic neuroma may be good candidates for neuroma surgery. Unfortunately, there are many, many other causes of chronic pain than neuromas, so not all patients with chronic pain are candidates for this surgery. Dr. Chang will perform a comprehensive history and physical examination to determine if you are a good candidate for this surgery. 

  •  Positive Response to Diagnostic Nerve Block – If you have physical exam findings consistent with a symptomatic neuroma, Dr. Chang will recommend a diagnostic nerve block as a predictor of your outcome after neuroma surgery. An injection of local anesthetic (numbing medication) will be injected around the suspected neuroma. If the nerve block significantly improves your pain, then you are a good candidate for surgery. 

  • Willing to Accept Permanent Numbness – In the majority of cases, the normal sensation provided by the injured nerve will not be restored by neuroma surgery. While an attempt will be made to restore the native function of the injured nerve, the goal of neuroma surgery is to reduce the frequency and severity of pain, rather than achieve normal sensation. Patients must therefore be willing to accept permanent numbness in the sensory distribution of the injured nerve in exchange for a chance to have reduced pain. 

  • Reasonable Expectations – Peripheral nerve surgery, particularly pain surgery like neuroma surgery, is unfortunately very challenging and unpredictable. Even with the most advanced techniques and technologies, an individual’s outcome is largely determined by how their individual body responds to and heals from the surgery. The goal is reduced pain severity and frequency. It is unlikely that you will be 100% pain free 100% of the time. There is a chance that your pain changes in character or even worsens in frequency or severity. 

Who Is a candidate?

Amputations of Fingers/Toes

Major Upper or Lower Extremity Amputations

Orthopedic Trauma

Hernia Repair

Mastectomy 
 

Common Causes of Symptomatic Neuromas

  • Neuroma Excision – The neuroma is identified and excised until a healthy portion of the nerve is identified. 

  • Nerve Repair with Nerve Graft – In more rare cases, when the neuroma is in the middle of a nerve, the neuroma is excised, and the gap between the two healthy ends of the nerve is bridged with a nerve graft. The nerve graft may be harvested from an expendable, redundant nerve from your own body or a cadaveric nerve graft will be used. 

  • Physiologic Nerve Stabilization – For the majority of cases, in which the neuroma is located at the end of the nerve, Dr. Chang performs the advanced techniques of physiologic nerve stabilization. The injured nerve is connected to an expendable motor nerve. In doing so, the new nerve connection allows the regenerating nerve to grow in a more controlled, directional fashion, one that is less likely to create the same, painful neuroma tissue. Oftentimes, a muscle graft is wrapped around the new nerve connection to help capture and protect any sprouting nerve cells that escape the new pathway.


What Techniques Does Dr. Chang Use? 

  • Failure to Improve Pain Symptoms – One of the biggest risks of neuroma surgery is failure of the surgery to improve your symptoms. Even after resecting the neuroma and stabilizing the injured nerve, you still may be bothered by chronic pain. Very strict preoperative screening is important to maximize the chance that you will benefit from surgery.  

  • Worsened Pain Symptoms – In a small subset of patients, the injured nerve is so injured that further manipulation, even attempts at creating a healthier environment for the nerve, injures it further. This can result in worsened pain or trigger a phenomenon called complex regional pain syndrome (CRPS). 

  • Numbness – Although most patients are generally numb in the distribution of their injured nerve, by undergoing surgery, one should expect to have permanent numbness of the affected nerve. The exceptions are cases in which the neuroma occurs in the middle of the nerve, and the nerve is able to be repaired with a graft. 

  • Mild Muscle Weakness – In order to stabilize the injured nerve and optimize its chances at healing in a manner so as to not cause pain, a motor nerve is often used. This may result in weakness of that muscle. Only motor nerves that are redundant, meaning that there are multiple other motor nerves that control the same muscle function, are used as donor nerves. 

Complications

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