[goblue1998]

Tomorrow I will be scheduling my surgery to get the hardware removed from foot to see if that solves my nerve pain issues since they don't have other diagnosis. One thought was rsd but docs don't think so but doesn't prevent me from worrying. What questions should I ask surgeon tomorrow. Thanks

[Littlepaw]

GoBlue,

I am sending prayers your way for a successful procedure and healing. Ask your surgeon if they "tease out" and possibly mark cutaneous nerves to protect them. This is easily done and prevents scar neuromas to a degree. If they accidentally cut one how do they handle that? Is there nerve safe cautery available and do they have micro tools and loupe magnification if needed? What will they give you for anesthesia? Regional is good for keeping nerves calm. The latest info out of Stanford for preventing chronic pain is 900 mg neurontin immediately before procedure. The antibiotic minocycline post -op for a week prevent glia from activating which is something associated with chronic pain and CRPS. Will they, can they give you either of these?

Are you allowed immediate gentle range of motion? This helps keep nerves from scarring down....

Okay so that's a lot of stuff! Pick what you think is important and best of luck. Please let us know how you do and don't forget to hit Vitamin C for 6 weeks after.

Sending Healing Love, Littlepaw

[goblue1998]

Another update my new surgeon who may take my hardware out recommended I see another PM doc to get another consult on crop before we do surgery. Saw pm today whom I really liked. He is ordering 3 phase bone scan as diagnostick tool and depending results possible series of nerve blocks before surgery if I elect surgery. Glad they are being so cautious in case it is crps but hoping it is not.

[Littlepaw]

Hi Blue,

Thanks for the update. It is good they are being cautious and if a series of blocks takes care of it that's great! If not (even if it is CRPS) taking the staple out could potentially make a difference. I have read articles on CRPS going into remission if it was caused by an injured nerve, impingement or neuroma that was surgically addressed. I will try to post one I just read recently that was from a plastic surgery journal stating surgery should be considered in CRPS patients who were suspected of having a fixable nerve issue.

Sending hugs,

[goblue1998]

Had my bone scan Friday and my foot lit up at the hardware site. Anxiously awaiting official results but fear my worst fear might be confirmed and that it is crps. So upsetting for many reasons but mainly is because none of the other 6 docs diagnosed it even when I told them my surgeon thought it was and now I am year and half in since injury/surgery.

[goblue1998]

Little paw did you ever find any of the articles you referred too with hardware removal and crps. Thanks

[Littlepaw]

Hi Blue,

I am traveling now and can't get to my links on my home network. The study I was thinking of was not regarding hardware but addressing nerve injury (even cutaneous neuroma) if the nerve issue was causing CRPS. I will be back home late tomorrow and will try to find it. I did also read an article on hardware removal and pain decrease, not CRPS pain, but pain nonetheless.

I will work on this so you have the resources. Sorry about that. I just want to add that just because you lit up at the hardware site doesn't mean they shouldn't address it. Removing the pain contributor causing CRPS can make a difference even if some damage is already done.

[swimtime]

I've read similar articles regarding surgically addressing nerve injury to successfully treat CRPS. Here is one (there are other articles but I can't find them at the moment).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649919/

The difficulty with nerve injury and hardware is that the usual MRI imaging of the nerve for additional diagnostic purposes, after emg/ncs, isn't really an option. MRI can't usually be done with hardware in place. Can you find a place to do ultrasound of the nerves of the painful area? It may give you the additional information you need to decide on the surgery. I'm finding in my own search that not every hospital offers it, but ultrasound technology has advanced over the last 10-15 years to be able to give additional diagnostic information on nerve injuries.

Here's a link to Cleveland Clinic's ultrasound imaging for nerves info:

http://my.clevelandclinic.org/servic...rve-and-muscle

[RSD ME]

hi goblue. i hope everything goes well with your surgery tomorrow. i would personally get a second opinion from a neurologist and pm dr before doing surgery, but that's just my opinion. everyone is different. maybe you could show them some literature about rsd just in case you may have rsd. if you do they should be careful about doing surgery. if they do surgery then maybe they can do an intravenous nerveblock while you are getting surgery and i've heard that taking vit C prior and after surgery helps prevent spread if you do have rsd. whatever you do i will be praying for a speedy recovery. hopefully you don't have rsd and you will be fine. sending many soft hugs your way.
P.S. i've had rsd for almost five years now and have had three major surgeries since that time. though i have had some spread due to surgery the major spread i've had was due to accupuncture and just my rsd reaching stage three which i believe is atrophy and spread. so not all people get spread from surgery but it is possible so being that i am not a dr i would definitely get a second opinion prior to surgery if i were you. but that's just me. and though its hard try not to stress because that just makes symptoms worse. sending prayers and soft hugs your way.

[Littlepaw]

Hi Blue,

The first two articles have multiple treatments reviewed. The section on surgery for CRPS pain contributors is at the bottom of both.

The third article is an amazing case of CRPS remission from nerve resection.

The fourth is related to outcomes for nerve surgery on CRPS of the lower extremity.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193642/

http://www.painmedicinenews.com/down...PMNSE14_WM.pdf

http://rsds.org/wp-content/uploads/2...eve-CRPSII.pdf

http://www.ncbi.nlm.nih.gov/pubmed/20123284

Have they done a simple lidocaine injection at the point of maximal tenderness? If that point is where your staple is and numbing removes the pain that is good information to have...