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, and numbness or tingling. Often, the location of the pain, weakness, or tingling is not 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 permanent damage can occur to both the nerve and the muscles that the nerve strengthens. This can make surgery the only long-term option.
Evaluating Nerve Pain
Evaluation for nerve pain starts with you giving us a history of your problem: when and how it started, how it feels, and treatments you’ve tried. We also ask about 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 also 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 the findings of your physical, 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 other than surgical intervention.
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. Nerve entrapment can often affect both the right and left sides of your body; in this case, we can operate on each side a few weeks apart to lessen your overall recovery time. Your surgeon will typically wait until you are well enough to do simple self-care tasks like cooking and light cleaning before operating on the opposite side.
Nerve-release surgeries are an outpatient procedure, which means you arrive at the facility about a 30-90 minutes before your actual surgery time and do not have to stay overnight in the hospital.
Our staff will check you in and 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.
The anesthesia staff will discuss your options for medications during surgery. 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 discuss any limitations you will 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 surgery. After those few days, 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. Your surgeon will detail any post-surgery restrictions.
In 10-14 days after surgery, patients can expect see either their surgeon or a Physician Assistant. They will discuss what they found, what was done, and your recovery process. On average, it takes most patients a few weeks before they are 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. Other times, it can cause weakness in your hand, making it difficult to grip or pick up things. Repetitive movements like typing on a computer can 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. Through the second incision, a surgical tool is used to release the ligament.
Both surgeries have similar recovery times, getting you back to your desired activities in two to six weeks. Depending on the severity of the nerve damagee, 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 or incisions and it is covered with a bulky bandage. Typically, you can remove the bandaging 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 was found during your surgery. At that time, you are able to use the hand as tolerated, though the incision may be sore for up to a few months. Your surgeon will tell your family exactly what your restrictions are after surgery.
Cubital Tunnel Syndrome and Ulnar Nerve Release and Transposition
The ulnar nerve runs on the inside of the elbow; when you think you have hit your ?funny bone?, you are actually hitting your ulnar nerve. The nerve provides sensation to your little finger and half of your ring finger. This nerve can become pinched in the elbow, particularly when you bend your elbow. Occasionally the ulnar nerve can snap over the bone on the inside of your elbow (medial epicondyle) which causes pain and numbness in your little finger and ring finger. When this happens it is called cubital tunnel syndrome.
A cubital tunnel release is an outpatient procedure that is done with a general anesthetic in conjunction with a nerve block. This helps provides initial pain relief after your surgery. Your surgeon will create an incision along the inside of your elbow to allow them to view the muscles, blood vessels and nerve in the arm. They will separate the muscle and soft tissue until they reach the nerve, at which point they will release the structures pinching it?typically bands of soft tissue. This allows the nerve to glide freely in the arm and relieves the pain. Often times, your surgeon will also reposition or move the nerve to the top side of the medial epicondyle. This creates less stress on the nerve when your elbow is bent. After the surgery, your surgeon will close the incision with stitches, place a bulky dressing over the area and your arm will be placed 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 will meet with a Physician Assistant or your surgeon to review what was found during surgery. You are able to use the arm as tolerated after that point, but the incision may be sore for up to a few months. Your surgeon will tell your family exactly what your restrictions are after surgery.
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. This nerve 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 in conjunction with a nerve block. This helps provides initial pain relief after your surgery. Your surgeon will make an incision on the forearm near the elbow to view the muscles in the arm. They will separate the muscles until they reach the nerve, at which point they will release the structures 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 are able to use the 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. This helps provide initial pain relief after surgery.
Your surgeon will make an incision on the inside of your ankle to locate the nerve. Once it’s spotted, the nerve will be released from any soft tissue or anatomical variant that is compressing it. Once the surgery is completed, the incision is sewn up and a bulky dressing applied.
After this procedure, you will 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 tell your family exactly what your restrictions are after surgery.