Joint Denervation 101- A Surgical Solution to Chronic Joint Pain

Those who experience chronic joint pain may be able to achieve long term pain relief with nerve surgery. If you have been suffering from chronic joint pain and  attempted other treatments that were unsuccessful or are seeking a long-term solution without the need for daily pain medications, our surgeons at The Institute for Advanced Reconstruction may be able to help.

What is joint denervation surgery?

Our team of surgeons are experts in treating chronic joint pain with nerve surgery. In this video, Dr. Andrew Elkwood,  Dr. Michael Rose and Dr. Adam Saad, answer commonly asked questions relating to this procedure.

Q: What are the underlying causes of chronic joint pain?

Dr. Adam Saad: Some of the causes of chronic joint pain could be someone who broke a bone and the joint was injured, or someone who has arthritis and they get a knee replacement but they still have pain caused by the joint not working well. There are other causes like the nerves themselves can be directly injured, by something like car accident or even just by falling. Many joints can be injured but the most common ones tend to be the knee and the hip, as well as the wrists.

Q: What can cause nerve- related joint pain?

Dr. Adam Saad: Sometimes the nerves that supply feeling to the joint can become injured directly, and they can either get what is called a neuroma, which is the nerve building scar tissue, or the nerve can get the signals mixed up. The nerve keeps telling the body that there is a problem, but there is not actually a problem. So, in these patients where the nerve is injured, the nerve keeps firing, keeps sending that electrical signal to the brain, and it tells the brain that there is a problem with the joint even if there is no problem (resulting in pain signals to the brain). This can be caused by direct trauma or the nerve being injured from other reasons.

Q: How do you determine if the patient’s pain is nerve-related?

Dr. Andrew Elkwood:  As nerve surgeons, we often look for something called a Tinel’s sign. A Tinel’s sign is when you tap on a nerve and you get a little bit of an electric shock, which tells you there is a problem with the nerve at the point where you get that shock. This is a very important component of a nerve exam.

Q: What is joint denervation surgery and how can surgery alleviate chronic joint pain?

Dr. Andrew Elkwood:  What we do with joint denervation surgery is find those small nerves, they are not quite microscopic but many of them are as about as thin as a wire on a paperclip, we find those nerves and we cut them and hopefully that denervates the joint. By denervating the joint, you don’t really cause numbness to the skin and for the most part your proprioception (knowing where your joint is in space, is it bent, is it twisted, etc.) is not gone either. The goal of joint denervation surgery is just taking the pain away from a painful joint.

Q: Who might be a candidate for joint denervation surgery?

Dr. Michael Rose: The people who are candidates for joint denervation surgery are people who have had chronic pain in a joint that has been addressed by an orthopedic surgeon and they’ve come up with no real answer. The first way we look at joint pain is structural; you go to an orthopedic surgeon for example, and they will see if there’s anything that can be done and check if there’s a bone spur or a broken bone history that wasn’t addressed properly, some arthritis, or even joint replacement if it’s a knee we’re talking about. So there’s a number of things that might be addressed, but once those have been addressed and the orthopedist has done all they can do and can’t offer further solutions, at that point it might be time to consider joint denervation surgery. Because, if you can’t feel the joint then you can’t have the pain and you can go on with your life.

Q: What does recovery look like after surgery?

Dr. Michael Rose: Recovery from joint denervation surgery is actually very simple. You’re generally not doing anything orthopedically, meaning you aren’t doing anything with the joint itself. If you’ve had orthopedic surgery in the past, that recovery is a lot more intensive than joint denervation surgery. Usually we do these surgeries with relatively small incisions, and what we are doing is just finding the nerves that give that pain signal from the joint to your brain, so you have the sensation of pain. By cutting that nerve through a small incision, we can stop the signal, so you aren’t experiencing pain anymore. The recovery is very simple, it is just a few small incisions in a few key places around the joint we are denervating, and you get on with your life pretty quickly. We may immobilize you for a short period of time, but it’s usually not more than a few days and you don’t typically require physical therapy after.