Some nerve-entrapment conditions may require surgery – especially if conservative treatment options haven’t been successful. There are four common surgical releases:
• Carpal tunnel in the wrist;
• Cubital tunnel in the elbow;
• Radial tunnel in the forearm; and
• Tarsal tunnel in the ankle.
When nerves become pinched because of inflammation in the tunnel or tissue pushing on the nerve, it can cause pain, weakness, numbness, or tingling. Often, the location of the pain, weakness, or tingling isn’t where the nerve is pinched but where the nerve provides feeling.
You and your surgeon can explore many conservative options prior to surgery, including bracing, padding, physical therapy, and activity modification.
However, sometimes the nerve is pinched so badly that it can cause permanent damage to both the nerve and the muscles that the nerve strengthens. This can make surgery the only long-term option.
Evaluating Nerve Pain
Nerve-pain evaluation starts with you telling us when and how it started, how it feels, treatments you’ve tried, and other medical conditions that may contribute to your nerve pain.
We do a physical exam to test the structures of the affected body part, checking your range of motion and strength, and do tests to uncover specific problems. We often evaluate the neck for upper-extremity conditions and the lower back for lower-extremity conditions. Sometimes a nerve is pinched in the spine, causing similar symptoms.
Based on what we find, we may need input from other specialists (particularly neurologists) to evaluate and test the nerve supply to the affected arm or leg and determine the severity of the injury. This helps us locate the specific location of the pinched nerve. If the nerve is being pinched in the neck or low back, we may refer you to a spine specialist for treatment.
If testing shows that surgical release of the nerve is necessary, your surgeon will review the results of your neurologic testing and go over treatment options.
Sometimes multiple conditions can be treated with one operation. For example, cubital and carpal tunnel releases on the same arm can be done together. Similarly, nerve entrapment can affect both the right and left sides of your body; we can operate on each side a few weeks apart to lessen your overall recovery time. Your surgeon will typically wait until you’re well enough to do simple self-care tasks like cooking and light cleaning before operating on the opposite side.
Nerve-release surgeries are outpatient procedures, which means you arrive at the facility about 30-90 minutes before your actual surgery time and don’t have to stay overnight in the hospital.
Our staff will check you in, have you change into a surgical gown, listen to your heart and lungs, and check your blood pressure, pulse, and temperature. We then start an IV to give you fluids and medications and prep the skin around the surgery area.
The anesthesia staff will meet with you, review your health history, past surgeries, and current medications, and discuss your anesthesia options.
A general anesthetic is often used to put you to sleep. With carpal tunnel surgery, a local anesthetic can be used, which lets you wake up faster and leave the surgery center sooner. A general anesthetic typically takes longer to wear off but allows deeper relaxation during surgery for radial, cubital, or tarsal tunnel releases. Your surgery can last 30 minutes to one hour, depending on how much tissue needs to be released.
After surgery, your surgeon will explain what they found and any limitations you’ll have using your arm or leg. You may be placed in a sling or on crutches depending on your surgery. Usually, your surgeon will ask you to just rest and recover for a few days. After that, you may remove the bulky surgical dressing and shower.
It can be difficult to care for yourself after surgery, and you may need extra help. Don’t be afraid to ask for help if you need it.
In 10-14 days after surgery, patients can expect to see either their surgeon or a Physician Assistant to discuss what they found, what was done, and your recovery process. It generally takes most patients a few weeks before they’re back to their everyday activities, but scar tenderness can take up to six months to resolve completely. If you have severe damage or loss of sensation to an area, it can take up to a year for you to reach full recovery.
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Carpal Tunnel Syndrome and Open or Endoscopic Release
Your wrist is made up of a series of bones called carpals. On the palm side of your hand, a band runs across your wrist, creating a tunnel between the carpal bones. A group of tendons and the median nerve travel through this tunnel.
Sometimes inflammation or swelling in this tunnel causes the nerve to become trapped or pinched, resulting in numbness or tingling in the palm of your hand – carpal tunnel syndrome.
Carpal tunnel can cause weakness in your hand, making it hard to grip or pick up things. Repetitive movements like typing on a computer can also cause this condition; however, sometimes it’s simply based on genetics and your anatomy.
Two types of surgery can fix this condition: open or endoscopic release. An open release is more common.
During open release surgery, an incision is made perpendicular to the wrist and the ligament band covering the carpal tunnel (on the palm side of the wrist) is released, allowing more space for the nerve.
During the endoscopic release, your surgeon makes two smaller incisions at your wrist. An endoscope or small surgical camera is placed into your wrist through one incision. A surgical tool is inserted through the second incision and used to release the ligament.
Both surgeries have similar recovery times, getting you back to desired activities in two to six weeks. Depending on the severity of the nerve damage, it can take up to a year before you reach maximum recovery of sensation in your hand. Even after surgery, sometimes full sensation never returns, which is why it’s important to be evaluated sooner rather than later.
After this procedure, stitches are used to close your incision(s) and covered with a bulky bandage. Typically, you can remove the bandage 24-48 hours after surgery and are allowed to bathe; however, the hand should not be soaked in water.
Your stitches will be removed 10-14 days after surgery when you meet with a Physician Assistant or your surgeon to review what they found during your surgery. At that time, you can use your hand as tolerated, though the incision may be sore for up to a few months. Your surgeon will discuss your post-surgery restrictions with your family.
Cubital Tunnel Syndrome and Ulnar Nerve Release and Transposition
The ulnar nerve runs on the inside of the elbow; when you think you’ve hit your “funny bone,” you’re actually hitting your ulnar nerve. The nerve provides sensation to your little finger and half of your ring finger, but can become pinched in your elbow, especially when you bend it.
Occasionally the ulnar nerve can snap over the bone on the inside of your elbow (the medial epicondyle), causing pain and numbness in your little finger and ring finger. This is called cubital tunnel syndrome.
A cubital tunnel release is an outpatient procedure done with a general anesthetic and a nerve block. This helps provides initial pain relief after your surgery.
In this surgery, your surgeon makes an incision along the inside of your elbow so they can view the muscles, blood vessels and nerves in your arm. They separate the muscle and soft tissue until they reach the ulnar nerve, at which point they release whatever’s pinching it – typically bands of soft tissue. This lets the nerve glide freely in the arm and relieves the pain.
Your surgeon may also move the nerve to the top side of the medial epicondyle. This creates less stress on the nerve when your elbow is bent.
After surgery, your surgeon will close the incision with stitches, place a bulky dressing over the area and put your arm in a sling. Typically, you can remove the bandaging in 24-48 hours after surgery and can shower at that point.
The stitches are removed about 10-14 days after surgery, when you meet with a Physician Assistant or your surgeon to review what they found during surgery. You can use your arm as tolerated after that point, but the incision may be sore for up to a few months. Your surgeon will discuss post-surgery restrictions with your family.
Radial Tunnel Syndrome and Release
The radial nerve runs on the top side of the forearm under the muscles. The nerve helps extend the wrist and bring your hand back, and provides sensation to the back side of your hand.
There are a variety of reasons why this nerve can become pinched in the muscles of the forearm. This can cause pain in the forearm and loss of sensation on the backside of your hand.
A radial tunnel release is an outpatient procedure done with a general anesthetic and a nerve block, to help provide initial pain relief after surgery.
In this surgery, your surgeon makes an incision on the forearm near the elbow so they can view the arm muscles. They separate the muscles until they reach the nerve, and release whatever’s pinching it – typically bands of soft tissue. This lets the nerve glide freely in the arm and relieves pain.
After surgery, your surgeon closes the incision with stitches and places a bulky dressing over the area. Typically you can remove the bandaging 24-48 hours after surgery and can shower.
The stitches are removed about 10-14 days after surgery when you will meet with a Physician Assistant or your surgeon to review what was found during surgery. You can use your arm as tolerated after that point, but the incision may be sore for up to a few months. Your surgeon will discuss post-surgery restrictions with your family.
Tarsal Tunnel Syndrome and Tarsal Tunnel Release
The tibial nerve runs down the inside of your ankle and provides sensation to the bottom of the foot. This nerve can become compressed by soft tissue bands or anatomical variants.
When you suffer from tarsal tunnel, you can experience numbness, tingling, pain, and/or burning on the undersurface of your foot.
A tarsal tunnel release is an outpatient procedure done with a general anesthetic in conjunction with a nerve block, to help provide initial pain relief after surgery.
This surgery starts with your surgeon making an incision on the inside of your ankle to locate the nerve. Once it’s spotted, the nerve will be released from whatever is compressing it.
After the surgery is done, the incision is sewn up and a bulky dressing applied. You’ll be placed in a CAM boot and will use crutches, not placing any weight on the ankle.
When you go for your first post-operative visit with a Physician Assistant or surgeon, your stitches will be removed and you will discuss bearing weight on your ankle again.
Typically patients are back to their everyday activities in a few weeks, but it can take up to a year to fully recover, as the nerve heals very gradually. Your surgeon will discuss your post-surgery restrictions with your family.