Upper extremity nerve injuries are common. According to the National Institutes of Health, patients report nearly 8 million cases every year.*  These injuries frequently impact both quality of life and daily functioning. So, there’s a need to deliver innovative, advanced therapies that can restore muscle capabilities and relieve pain.

Maimonides is fulfilling this need through its Bone and Joint Center. As New York’s No. 2 center for orthopedic surgery and the city’s only center to receive the Healthgrades’ Orthopedic Surgery Excellence Award for three years in a row (2022-2024), Maimonides is one of the few local institutions that provides a multidisciplinary approach to delivering leading-edge nerve injury treatments for hand and wrist injuries. Nerve transfer surgery—a procedure that replaces a nonfunctioning or damaged nerve with a healthy one—is one of its most unique surgical offerings.

“Nerve transfer surgery remains a specialized and relatively rare practice across the country — it’s a niche practice,” says Issac Gammal, MD, orthopedic hand surgeon at Maimonides Bone & Jone Center. “Few centers nationwide offer this advanced procedure, and we are proud to make it available right here in Brooklyn.”  

Delivering Complex Nerve Injury Treatment 

Upper extremity nerve injuries are complex. They can result from congenital disorders or trauma. Treating these conditions requires a high level of precision and expertise. Maimonides providers are highly skilled in performing these procedures, aiming to restore muscle control and reduce pain for patients.  

With extensive training in microsurgical orthopedic procedures for the hand, as well as peripheral nerve surgery, Dr. Gammal leads Maimondes’ nerve transfer surgery program. He performs these complicated procedures for many patients every year. 

To help patients with nerve injuries, he completes: 

• Nerve transfers to restore muscle function: These procedures redirect expendable nerves linked to a different muscle to bypass the patient’s existing nerve injury and restore their function.  

• Supercharged end-to-side transfer: This technique treats chronic nerve compression. Surgeons connect the injured nerve to a healthy donor nerve to trigger nerve regeneration.  

Patients who have exposed nerve endings after an amputation need a nerve transfer procedure called targeted muscle reinnervation. This surgery connects a patient’s nerves to myoelectric prosthetic devices that move in response to nerve signals. It can also reduce phantom limb pain. Although Maimonides doesn’t offer this procedure, Dr. Gammal refers patients to dedicated amputation centers through existing relationships with these specialists. 

A Multidisciplinary Approach to Nerve Injury Therapy 

Nerve transfer surgery is a complex procedure that requires multidisciplinary partnership, Dr. Gammal says. While surgeons may perform the procedures, delivering the high level of care these patients need involves partnerships across various specialties.

At Maimonides, the collaborative care process begins with a comprehensive evaluation of each person’s condition.  

“We start with a full, in-office evaluation to assess the patient’s functional deficits and determine what can be restored with nerve transfer,” Dr. Gammal explains. “Then, our electrophysiology partners conduct electrodiagnostic testing to measure the extent of the patient’s nerve injury and potential for recovery.”  

Diagnostic radiologists capture CT and MRI scans, providing essential guidance for the neurologists and orthopedic and trauma surgeons who perform these intricate procedures either at Maimonides Medical Center or the Bone & Joint Center’s Brooklyn Surgery Center practice. To ensure precision, Maimonides surgeons use several advanced microsurgical tools and protocols, including: 

• Checkpoint devices to stimulate nerves during surgery. 

• Nerve conduits (wraps) to repair peripheral nerve injuries and create a protective microenvironment that fosters nerve regeneration. 

• Nerve grafting to use healthy nerves to reconstruct injured or damaged ones. 

• Surgical microscopes and micro-sutures to enhance visualization of the patient’s nerves.  

After surgery, patients benefit from a holistic approach to recovery, with access to physical and occupational therapists who help them rebuild their strength. Psychiatrists can address any mental health concerns as needed. 

Improving Patients’ Quality of Life 

At its core, nerve transfer surgery is a transformative procedure that significantly enhances a patient’s quality of life, Dr. Gammal says.

“This surgery can improve lives in many ways. If a patient has lost certain motor functions, the procedure can potentially restore them to near pre-injury levels,” he explains. “Additionally, it combats issues related to chronic nerve pain — a condition for which effective treatments are limited. For those suffering from chronic pain, nerve transfer surgery offers a potential pathway to relieve that discomfort.”

Patients also benefit from convenient access to this complex procedure and Maimonides’ comprehensive approach to care. Since every nerve injury or nerve condition is unique, the Maimonides team takes an individualized approach to care. In many cases, this personalized care results in pain relief that patients didn’t think was possible, Dr. Gammal says. 

“Many patients with traumatic injuries or long-standing nerve pain feel like they’ve exhausted all options — that there’s nothing more that can be done,” he says. “This treatment, now available to them, offers the potential to alleviate their pain and improve their function.”

For more information on hand and wrist orthopedic surgery at Maimonides, visit https://maimo.org/treatments-care/bone-and-joint-center/orthopedic-services-and-procedures/hand-wrist-orthopedic-surgery/. To refer a patient, call (718) 283-7400.  

* https://www.ncbi.nlm.nih.gov/books/NBK553109/