Nerve Decompression Surgery

Nerve decompression is a minimally invasive peripheral nerve surgery applied to relieve pressure of a nerve.

Patients experiencing any combination of numbness, burning sensation, pain or muscle weakness (along the anatomical distribution of peripheral nerves with known upper or lower extremity compression sites) have peripheral neuropathy.

A primary care physician or a specialist should conduct a work-up that will help determine its cause and exclude other non-peripheral nerve related conditions. Patients with previous brain or spine surgery are poor candidates for peripheral nerve surgery.

In addition to surgery or trauma, other common reasons for neuropathy include diabetes, hypothyroidism, certain autoimmune conditions, vitamin deficiencies, and certain drugs (chemotherapy, lipid lowering medications and some anti-viral drugs). It is very important that medical treatment for these conditions is undertaken, as your doctor prescribed it.

I find that the patients who, despite optimal medical treatment for their condition, are continuing to experience the above mentioned signs/symptoms of symptomatic peripheral neuropathy are appropriate surgical candidates. Upon referral, I would determine if any additional work-up is needed and would verify if, when and what type of the intervention is required.

Interactive schematic drawings of the most common examples are (see text below drawing for definitions and more information prior to clicking on schematic drawing link with your interest)

Upper Extremity Peripheral Neuropathies

These are patients who present with numbness in the fingers or hand with or without muscle weakness due to compression of the nerves. There are several anatomical sites along upper extremity where nerves can become compressed causing functional hand problems (numbness and/or weakness). Diabetic patients often have these symptoms despite optimal medical care.

Examples include:

Carpal tunnel syndrome

Numbness/paresthesia in the first three fingers of the hand due to median nerve compression at the wrist.

Cubital tunnel syndrome

Numbness/paresthesia in the 4th & 5th fingers or hand weakness due to ulnar nerve compression at the elbow, rarely the wrist.

Radial nerve compression

Forearm pain with weakness in hand dorsiflexion or finger extension due to radial nerve / posterior interoseus nerve compression at proximal anterolateral forearm. If radial sensory nerve is compressed at mid-distal anterolateral forearm (Wartenberg’s disease), then numbness/paresthesia along the dorsum of hand/fingers are dominate presentation).

Thoracic outlet syndrome

Compression of brachial plexus affecting arm circulation upon arm elevation or causing numbness, pain or paresthesias of upper extremity/hand due to cervical rib or traction stretch injury of plexus nerves.

Lower Extremity Peripheral Neuropathies

Similar to patients with upper extremity problems, patients with lower extremity nerve compressions can present with numbness, pain and/or a burning sensation involving the leg and/or foot. Diabetic patients often have these symptoms despite appropriate medical care.

Examples of several anatomical sites of lower extremity nerve compression include:

Meralgia paresthetica

Numbness, pain and/or a burning sensation along the anterolateral thigh, due to compression of lateral femoral cutaneous nerve (LFCN) at the anterior superior iliac spine and inguinal ligament.

Peroneal nerve compression

Foot drop, top of the foot numbness and/or pain worse with activities. Usually with a history of previous knee trauma or ankle sprain.

Tibial Nerve / Tarsal tunnel syndrome

Bottom of the foot numbness, pain and/or burning sensation due to tibial and inner ankle nerve compressions. Tibial nerve compression can also be present at the posterior proximal calf area, as suggested by pain on exam. Tarsal tunnel syndrome is common in diabetic patients.

Diabetic Peripheral Neuropathy

Diabetic patients can have numbness, pain or burning sensations in the upper or lower extremities not only due to the effect of diabetes on the nerve itself, but also due to concurrent compression of nerves within tight tunnels. If neuropathy symptoms continue along (distal to) known anatomical nerve compression sites despite optimal medical care, referral to peripheral nerve surgeon is warranted. Peripheral nerve surgery, if applied early, can help prevent permanent nerve damage (permanent numbness).

As for other common aforementioned neuropathies, it is very important that surgical treatment of these patients, if and when indicated is done in a timely manner, as prolonged ‘observation’ can lead to irreversible nerve damage. After this occurs, regardless if patient is diabetic or not, no surgery will be helpful. If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.

You should also know:

What is actually done during nerve decompression surgery?

Usually under general anesthesia, a small incision in skin, overlying anatomical nerve compression area is made and deepened through anatomical planes. When operating on an extremit, unless contraindicated, a tourniquet is applied proximal to the operative site to provide a bloodless field. In this case, blood loss is nearly none, completely eliminating any need for blood transfusions. Once the nerve is identified, using proper microsurgical instruments and techniques, anatomical structures overlying the nerve (tunnels) are incised. Release of these tight fascial bands and tissues or vessels pressing on the nerve (neurolysis) enable more normal nerve function, nerve regeneration, and subsequent reduction or elimination of neuropathy symptoms. During neurolysis, the nerve is not cut and no major manipulation of the nerve is done. In the case of advanced neuropathy or nerve damage, surgery may fail to reverse the pre-operative condition, this is why timely intervention is so important in nerve surgery.

Surgery: Inpatient, outpatient, its duration, recovery?

Most, if not all of the above treatments are done on an outpatient basis, unless your pre-existing medical condition warrants admission. It takes in average one hour to perform the surgery where nerves are decompressed (neurolysed) within a compressive anatomic compartment.

Dressings are removed, on average, in one week, while sutures are removed about three weeks after surgery.

Ambulation, in general, depending on the personal level of discomfort, is permitted right after surgery. Following lower extremity, some patients prefer to use crutches during the immediate post-operative period.

Recovery varies but it usually takes about two-three weeks, which can vary depending on several variables (type of professional work done, age, co-morbidities, etc).

Incisions: how long of a scar should I anticipate?

I use minimally invasive techniques that spare other nerves in the hand and wrist. Other advantages of using a minimally invasive approach include a quicker recovery, potentially reduced possibility of infection and faster return to full function of the affected hand. In fact, I recently authored a study introducing, for the first time, minimally invasive peripheral nerve surgery for various nerve decompressions.

I also perform revision surgeries, which are surgeries to repair scarring and other trauma from past surgeries.