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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35468
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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My son had an accident approx. 4 years ago. He was on a quad

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My son had an accident approx. 4 years ago. He was on a quad bike and caught his lower leg crushed between the frame of the bike and a fence post. At the time there was talk of compartment syndrome but as there where other symptoms this was ruled out. Since then he has had surgery to try and resolve the problems caused by compartment syndrome. He now has extreme pain and has been told that the nerves are approx. 3 times their normal size and it looks as though amputation is the only solution. His bone structure is intact and the problems seems to be mainly nerves. Can you give me some idea of options to try to prevent amputation as this does seem rather extreme.

Hello Catherine ,

My name is***** and I will be helping you today.

Did the MRI show the nerves increased in size?

What is the exact reason for amputation given; non use of limb, painful limb or any other reason?

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Customer: replied 4 years ago.

Nerves approx. 3-4 times normal size. Reason given was pain and possible scar tissue from a previous surgery to 'bury' nerves.

Hello Catherine,

Were treatment like shots in the nerves, stimulation tried?
Is he able to bear full weight on the limb?

Dr. Arun
Customer: replied 4 years ago.

He can bear full weight. Apart from the surgery to try to correct the tendon and tissue damage from undiagnosed compartment syndrome and the 'burying of the nerves', there has been no other nerve treatment. He has been offered strong pain relief but does not like them as he cannot function on them.

Hello Catherine,

With his uncontrolled pain a diagnosis of chronic regional pain syndrome (CRPS) would be the possibility. Following should be integrated in the management;

1) Physical therapy and occupational therapy, plays an important role in functional restoration.

2) Recreational therapy; take part in pleasurable activities that help to decrease pain.

3) Vocational therapy; provide work capacities and targeted work hardening, and one may return to gainful employment.

4) Sympathetic blocks

5) Bier block (intravenous regional block)

6) Continuous epidural infusion

7) Spinal cord stimulator

8) Baclofen pump; Intrathecal infusion (Intrathecal bupivacaine infusion or Morphine pump are the other alternatives)

9) Sympathectomy; Surgical sympathectomy or Chemical sympathectomy or Radio frequency or cryoprobe lesioning should be considered.

10) Acupuncture

11) Relaxation techniques; associated with the above treatment.

12) Biofeedback training

He needs to consult following specialists;

a) Pain management physician

b) MD in physical medicine and rehabilitation

These are likely to prevent amputation.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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