Hand Surgery

Patients who have had peripheral nerve surgery generally do well, but when surgery doesn't deliver the expected result and significant pain or loss of function persists, the experience is uniquely difficult. Dr. Brian Kelley, a fellowship-trained hand and peripheral nerve surgeon in Austin, explains when a second opinion is reasonable, why specialist experience matters for complex nerve revision, what the evaluation actually involves, and what options exist — including when more surgery is and isn't the answer.

WALANT — wide awake local anesthesia no tourniquet — lets common hand procedures like carpal tunnel and trigger finger release be done with the patient fully awake, without sedation, general anesthesia, or a tourniquet. Dr. Brian Kelley explains how the lidocaine-and-epinephrine technique works, why injecting epinephrine into the hand is safe, and how it compares on recovery, cost, and patient-reported outcomes. Randomized data show less postoperative pain, lower analgesic use, and higher satisfaction than conventional anesthesia.

Most patients do well after carpal tunnel or cubital tunnel release, but a meaningful minority have symptoms that persist, recur, or never fully resolve — and the experience is discouraging. Dr. Brian Kelley, a hand and peripheral nerve surgeon in Austin, explains why decompression sometimes doesn't produce complete relief, what the published outcomes data actually show, the role of repeat EMG before revision, and what options exist — including when nerve reconstruction is needed.

Being told your nerve test is normal when the pain is unmistakably real is frustrating — and the assumption behind it is wrong. A normal EMG does not rule out nerve compression. Dr. Brian Kelley, a hand and peripheral nerve surgeon in Austin, explains why these tests miss many real cases — from carpal and cubital tunnel to small-fiber neuropathy and other compression syndromes — how the diagnosis is actually made, and when treatment is appropriate despite normal testing.