As a Houston, Texas medical malpractice attorney, I have had several occasions to encounter surgeons use the excuse of neurapraxia (some people spell it neuropraxia) to explain away surgical mistakes.
What is neurapraxia?
Neurapraxia is a temporary, relatively mild injury caused by some sort of trauma. It can happen when an area of the body is hit hard, or during surgery when a nerve is temporarily compressed or stretched.
Many patients describe neurapraxia symptoms as including pain, numbness, and/or tingling.
Experts explain that, more precisely, neurapraxia is damage to the outer covering of the nerve, called the myelin sheath, rather than the nerve itself. Therefore, in neurapraxia, the nerve still functions, but just at a slower rate while the myelin repairs itself.
The neurapraxia excuse
I am working on two cases right now that illustrate how neurapraxia can be used as an excuse when, in fact, there is a more serious underlying nerve injury.
In one case, a woman consulted a plastic surgeon about removing her existing breast implants and replacing them with larger ones. Without discussing the risks involved, he took her to surgery to place implants that were over double the size of her original implants. This not only violated the manufacturer’s recommendations, but also placed her at an extreme risk of a nerve injury during the procedure.
Sure enough, after the surgery, she experienced continuous severe pain around one of her breasts. The surgeon told her not to worry, because it was a temporary, neurapraxia, and would go away on its own within a few months.
In another case, I recently took the deposition of an orthopedic surgeon who did the lumbar spine surgery on a patient. Quickly after the surgery, the patient complained of numbness and tingling from the waist down, and also had no control of his bathroom functions. At deposition, the surgeon testified that he thought all of the man’s problem for because of neurapraxia that was an unavoidable consequence of the surgery. Curiously, though, when the patient did not get better after three months, he blamed the ongoing symptoms on arachnoiditis.
This really makes no sense at all, but the surgeon said it with a straight face.
It is hard to know for sure why some surgeons point to neurapraxia as an explanation for patient complaints like numbness, tingling, and pain. Are they unwilling to consider that they may have made a mistake in the operating room? Or are they just wearing rosy glasses and hoping that things will get better?
The risk to patients when surgeons will not consider all possibilities to explain abnormal symptoms, like pain, numbness, and tingling, is that waiting for three months to let neurapraxia resolve means that some treatment options will no longer be on the table.
In the orthopedic surgery case that I discussed above, our medical expert says that the surgeon was wrong. The patient’s symptoms were not caused by neurapraxia, but rather a hematoma that developed after the surgery, which was compressing his spine. If the surgeon had considered this is a possibility and worked it up appropriately with a non-invasive MRI, he could have taken the patient back to surgery to decompress the spine by removing the hematoma. Instead, he left it there and now the patient’s condition and deficits are permanent.
Similarly, the expert witness who reviewed the plastic surgery case that I discussed above believes that the surgeon accidentally cut a nerve during the breast implant procedure. If he had investigated the cause of her pain, rather than jumping to the presumption that it was neurapraxia, a nerve graft would likely have alleviated her symptoms. Now, it is too late for that.
If you have a surgery and then experience new concerning symptoms, you should ask some questions if your surgery says it's just neurapraxia. While the surgeon may not worry about it, you should make sure that he or she didn't skip over any important steps in the diagnosis process.
Ask the surgeon why he or she thinks your symptoms are caused by neurapraxia and to tell you about the other possible conditions that are a possibility. Next, ask it an MRI or other test would be appropriate and help everyone know for sure.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. He member of the board of directors of the Houston Bar Association, and an editorial board member of the Texas Bar Journal. In 2018, he was honored by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.