What to expect
All our patients are unique, and no two journeys through diagnosis treatment and onward care are exactly the same. That’s why Mr Sinisi will work with you to come up with a fully personalised treatment plan based on your individual needs.
There is however, some shared ground. While recovery times may vary and experiences differ, we hope that the following points will give you some idea of what to expect and answer some of the most common questions patients ask about our treatments.
For each of the treatments below, there is a section looking at what happens following surgery. One constant with all treatments is that patience will prove as important as physiotherapy. Nerves take much longer than bones to heal and recovery will be slow. You’ll have our support, with exercises and advice from our incredible multidisciplinary team, but ultimately you’re the most important member of our team. The hours are long, but the benefits of a full recovery are amazing.
In order to give you all the care you need at every stage of your health journey, Mr Sinisi works as part of a multidisciplinary team. Should you need it, you’ll have access to specialist nurses, physiotherapists, oncologists and occupational therapists.
While extensive, the list below isn’t exhaustive. If you can’t find the treatment you’re looking for here, please don’t hesitate to get in touch. Our team will do whatever they can to help.
Nerve reconstruction surgery
What is nerve reconstruction surgery?
Nerve reconstruction surgery is a complex procedure used to restore feeling and regain muscle use after injury or damage (sometimes following surgery) has left a patient with ongoing pain, numbness and/or paralysis.
It might help to think of your nerves as cables that carry messages in the form of tiny electrical impulses between the brain and the rest of your body.
When a nerve becomes damaged or injured, through trauma for example, or even a previous surgery, it may stop sending these signals. This can result in pain, numbness and an inability to use your muscles.
Nerve reconstruction, during which Mr Sinisi reconnects the ends of the nerve, is one solution to restore function to the affected area.
How should I prepare for surgery?
Before your procedure, Mr Sinisi will explain what will happen during surgery and answer any questions you may have.
Typically, you can go home after the surgery and won’t need to stay overnight. You’ll need someone to go with you however, as you won't be able to drive.
No procedure is risk-free and nerve reconstruction carries the same risks as any other surgery, such as infection or possible scarring. Mr Sinisi will discuss these with you fully before the procedure.
What happens during nerve reconstruction surgery?
There are two potential options, nerve repair and nerve graft. Mr Sinisi will talk to you about which approach is right for your specific circumstances, but the following is designed to give you a clear overview in the meantime.
Nerve repair
Nerve repair surgery involves reattaching two edges of a severed nerve. It’s typically carried out immediately following an accident or trauma, and is conducted under general anaesthetic.
During this procedure, Mr Sinisi removes the damaged tissue from the nerve ending and, with the aid of a microscope, realigns the fibres within the nerve. Once these fibres are aligned, he reattaches them.
Nerve graft
However, if there’s significant nerve damage, Mr Sinisi may need to remove a substantial amount of the damaged nerve, leaving it too short to reattach. In this case, he may carry out a procedure called a nerve graft. Working with a microscope and very fine sutures, designed specifically for this technique, Mr Sinisi takes a nerve from another part of the body and divides it into strands in order to bridge the gap between the two damaged nerve parts.
This allows the part of the nerve that’s still alive to regenerate through the graft and into the other segment of the nerve, giving the potential to reconnect the muscles and the skin that have been affected by the trauma.
What happens after my surgery?
Following the procedure comes the recovery. You’ll need to strengthen the newly attached nerve fibres, and physiotherapy plays a vital role in this. After three weeks or so, your physio will give you exercises to help restore function. They may also suggest the use of electrical sensory and motor stimulation therapy to help with your recovery of the repaired nerve.
If you can’t find the information you need, or have any other questions about this procedure, please get in touch. Our team will be more than happy to help.
Brachial plexus surgery
What is brachial plexus surgery?
The brachial plexus is a collection of five nerves that originate high in the spinal cord at the neck. You have two – one for each side of the body. Its job is to connect the brain and spinal cord to the nerves in the arms and shoulders, allowing you to move and feel sensation.
Brachial plexus surgery is, put simply, a procedure to reattach or repair one or more of these nerves.
How should I prepare for surgery?
What happens during brachial plexus surgery?
The type of procedure you’ll have will depend on the nature of your injury. The sooner after the injury nerve attachment can take place, the more likely it is to be successful. Typically, you’ll be under general anaesthetic and Mr Sinisi will access the nerves through a cut above the collarbone.
Nerve repair involves reattaching the two edges of a severed nerve, and is usually carried out immediately after a trauma.
In cases where a nerve is lacerated, a nerve graft may be needed. This is where a healthy nerve from another part of the body is used to hold the lacerated nerve together. Over time, the nerve fibres regenerate and reconnect with the muscle tissue.
What happens after my surgery?
Nerve regrowth can be a slow process, so it may take several months/years after surgery for you to feel the results.
During this time, physiotherapy will be key to your recovery. Along with prescribing pain relief medication, we’ll assign a physiotherapist to guide you through exercises for your shoulder, elbow, wrist, and fingers to prevent stiffness and strengthen the muscles.
Following these exercises is vital to ensure you make steady and sustained progress. Your physiotherapist will also teach you the best way to perform day-to-day activities such as eating and bathing with limited mobility – particularly if you need to wear a splint to support your arm.
If you can’t find the information you need, or have any other questions about this procedure, please get in touch. Our team will be more than happy to help.
Obstetric brachial plexus (to treat Erb's palsy)
A note to parents
It’s bad enough when we adults are injured or unwell, but when it’s your child in need of medical attention, the impact can be devastating, with anxiety and uncertainty seemingly clouding every decision.
Mr Sinisi’s only goal is to ensure the best possible outcome for your child, and give you the reassurance you need that you’re in the best possible hands.
Each child is different, and recovery will look different for each and every one of them. Mr Sinisi’s dedication and radical approach to this area led him to devise a pioneering technique that has radically improved outcomes for children just like yours.
If you’d like to find out more, or simply talk to him about the possible options, please don’t hesitate to get in touch.
What is Erb’s palsy?
Brachial plexus lesions in infants – commonly known as Erb’s palsy – is a specific area of interest for Mr Sinisi. These lesions often occur at birth, and can lead to growth abnormalities affecting the whole of the upper limb, particularly the shoulder. The difference in recovery can vary substantially from case to case.
What happens during surgery to deal with the deformity of the shoulder?
Mr Sinisi’s approach to this surgery is both unique and ground-breaking.
In 2011, having operated on hundreds of children with shoulder abnormalities, Mr Sinisi came up with an entirely new method of dealing with the deformity. This involves remodelling the glenoid, which is the socket in the shoulder that houses the head of the humerus (the upper arm bone).
What happens after surgery?
As with all nerve reconstruction surgeries, recovery can be slow and physiotherapy will be key to success. Your physiotherapist will offer exercises and advice going forward to help your child in their prevent stiffness and strengthen the muscles.
If you can’t find the information you need, or have any other questions about this procedure, please get in touch. Our team will be more than happy to help.
Tendon transfer surgery
What is tendon transfer surgery?
When nerve function is lost, it can lead to a loss of muscle mass as the affected muscles begin to atrophy with no nerves present to stimulate them. If nerve surgery hasn’t helped, there are still options available. One of these is tendon transfer surgery.
Your tendons act as ropes, attaching your muscles to your bones. By transferring the healthy tendon from a working muscle onto a paralysed one, Mr Sinisi is able to restore some function to the affected muscle.
In extreme cases where tendon transfer isn’t viable, then free muscle transfers are another option. A complex operation, performed jointly with consultant plastic surgeon, Mr Anthony MacQuillan, this involves Mr Sinisi taking a muscle from the leg and re-plugging it into the artery vein and nerve to restore elbow or upper limb function.
How should I prepare for surgery?
It’s most likely that, before any suggestion of surgery, we’ll look at non-operative methods to strengthen your working muscles – either using supportive devices such as splints, or physiotherapy exercises.
If Mr Sinisi feels surgery is the most beneficial route, he’ll talk you through the procedure and put your mind at ease. You’ll most likely be under general anaesthesia for the surgery, so you won’t be able to eat or drink beforehand.
What happens during tendon transfer surgery?
What happens after surgery?
Patients usually stay with us in hospital for one night.
While many patients are able to return to work in a non-manual job within 2-4 weeks, complete recovery can take up to a year.
If you can’t find the information you need, or have any other questions about this procedure, please get in touch. Our team will be more than happy to help.
Ulnar nerve transposition surgery
What is the ulnar nerve?
The ulnar nerve runs down the back and along the inside of the arm carrying electrical signals to muscles in your forearm and hand.
When the ulnar nerve is compressed, it can lead to a tingling sensation and numbness in your hand and fingers. You may well have experienced a mild form of this after leaning on your arm for an extended period of time. However, if the nerve becomes entrapped, it can become painful and, in severe cases, lead to a loss of muscle mass and weakness.
How should I prepare for surgery?
What happens during an ulnar nerve transposition?
The procedure, which takes place under general anaesthetic, relieves pressure on the ulnar nerve by relocating it.
If the compression is located at the elbow, Mr Sinisi will make a cut at the front of your arm. He’ll then move the nerve from behind the medial epicondyle (the bony structure in front of the nerve) to in front of it. This will prevent it from becoming caught and causing pain when you bend your elbow.
What happens after surgery?
Many patients are able to go home the day of the operation, however we advise that you book a fortnight off work for your recovery.
You will need to move the arm right away, and avoid keeping it in a sling. You should also avoid driving for two weeks.
It’s also important to note that, while ulnar nerve transposition is a fairly straightforward procedure, it can take a few months before your symptoms improve.
If you can’t find the information you need, or have any other questions about this procedure, please get in touch. Our team will be more than happy to help.
Nerve decompression surgery
What is nerve decompression surgery?
Put simply, it’s surgery to relieve the pressure of a peripheral nerve that has become constricted. Typically it is used to treat conditions such as carpal tunnel syndrome (a compressed nerve in the wrist) and tarsal tunnel (compressed nerve in the ankle).
When the nerve becomes constricted, if not treated you may experience a number of symptoms, ranging from the short-term to the chronic. These include numbness, pain, muscle weakness, a burning sensation or sensitivity to touch.
How should I prepare for surgery?
What happens during the procedure?
What happens after surgery?
You should be able to go home the day of the procedure, but you’ll need to rest. If the procedure was performed after trauma, this may be longer. Mr Sinisi will let you know when you can get back to your usual routine, including work or exercise.
As nerve fibres grow back slowly, you may only feel the benefits of this procedure after some time. If the nerve damage is severe, you may not regain full function. Your consultant will answer any questions you may have.
If you can’t find the information you need, or have any other questions about this procedure, please get in touch. Our team will be more than happy to help.
Get in touch
Nerve tumour removal
What is nerve tumour removal surgery?
It is, as the name suggests, a procedure to remove peripheral nerve tumours. The key is to remove them as completely as possible, without damaging the nerve. Some tumours, known as schwannomas and neurofibromas, can be removed from within the nerve. In order to do this, Mr Sinisi will have to open up the nerve.
Your procedure will be carried out with the aid of microscopic vision. This will help Mr Sinisi to differentiate between the tumour and your healthy tissue.
It’s important to remember that while some peripheral nerve tumours may be malignant, the vast majority are benign and nothing to worry about. These tumours can grow anywhere in the body and can cause pain, numbness and, very rarely loss of function.
How should I prepare for surgery?
What happens during nerve tumour removal surgery?
Your treatment will depend on the location of your tumour.
If the tumour is located within a nerve, then Mr Sinisi will open the nerve and work within it.
What happens after surgery?
Mr Sinisi will visit you to discuss when you can get back to your usual routine. This will include your return to work and getting back to whatever exercise routine you had before surgery.
If your tumour is cancerous, you’ll be able to rely on the care of our dedicated oncology team. They’ll support you throughout your treatment, which will include access to radiotherapy and chemotherapy treatments if required.
If you can’t find the information you need, or have any other questions about this procedure, please get in touch. Our team will be more than happy to help.