Peripheral Nerve Surgery

A painful neuroma after surgery is a focal, treatable cause of chronic post-surgical pain that is often missed. Dr. Brian Kelley, an Austin nerve surgeon, walks through where neuromas form after specific operations — mastectomy and cancer resection, hernia repair, knee and joint surgery, and facial surgery — and what modern treatment looks like, including traditional excision and modern techniques like TMR and RPNI. PRO data and specialist evaluation criteria included.

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.

For many amputees, the hardest part of life after amputation is the pain. Targeted muscle reinnervation (TMR) is a surgery that reroutes cut nerves to nearby muscles, giving them a target and preventing the painful neuromas behind phantom limb and residual limb pain. Dr. Brian Kelley, trained in nerve surgery at the University of Michigan, explains how TMR works, what recovery involves, and what the patient-reported outcomes data show — including durable pain relief and reduced opioid use.

Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) both give a divided nerve a new target after amputation, preventing painful neuromas and enabling prosthetic control. TMR reroutes the nerve into an existing muscle; RPNI wraps it in a small free muscle graft. Dr. Brian Kelley, trained at the University of Michigan where RPNI was pioneered, explains how the two differ, when each is used, and what the published outcomes show.

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.

Peripheral nerve problems — nerve injuries, painful neuromas, compression syndromes that haven't responded to treatment, and chronic nerve pain — are among the more specialized problems in surgery, and finding the right surgeon can be difficult. Dr. Brian Kelley, a fellowship-trained nerve and microsurgeon in Austin, explains what peripheral nerve surgery covers, why specialized training and experience matter for these microsurgical procedures, what to look for in a surgeon, and how patients and referring providers can find one in Central Texas.

Regenerative Peripheral Nerve Interfaces (RPNIs) for established nerve pain work by giving divided nerves a new target, but relief develops over months, not weeks. The incision heals quickly; the nerve reorganizes slowly. Dr. Brian Kelley, trained at the University of Michigan where RPNI was pioneered, explains the recovery timeline, how nerve perception changes month by month, what imaging shows during healing, and the realistic outcomes and risks based on real evidence.

Breast sensation after mastectomy is typically reduced or absent, and a subset of patients develop chronic post-mastectomy pain. Nerve grafting, allograft, and innervated flap techniques can improve sensation in some patients, but normal pre-mastectomy sensation is essentially never restored. Dr Brian Kelley helps to summarize and explain the latest science.