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.
Inflammation in the tunnel or tissue pushing on the nerve can pinch nerves, causing 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
We often evaluate the neck for upper-extremity conditions and the lower back for lower-extremity conditions. Sometimes a pinched nerve in the spine causes symptoms.
Based on our findings, we may ask 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 there’s a pinched nerve in the neck or low back, we may refer you to a spine specialist.
Before Surgery
If testing dictates surgical release of the nerve, your surgeon will 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 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.
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After Surgery
After surgery, your surgeon will explain what they found and any limitations you’ll have using your arm or leg.
It generally takes most patients a few weeks before they’re back to 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 to reach full recovery.
Conditions Where Surgery May be Necessary
Your wrist is made up 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 traps or pinches the nerve, causing 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 cause carpal tunnel; however, sometimes it’s simply based on genetics and 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.
For an 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 inserted through the second incision releases the ligament.
Both surgeries have recovery times of two to six weeks. Depending on the severity of 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.
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 fingers. This is cubital tunnel syndrome.
A cubital tunnel release is an outpatient procedure done with a general anesthetic and a nerve block, for initial pain relief after 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 muscle and soft tissue until they reach the ulnar nerve, and then 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, to create less stress on the nerve when your elbow is bent.
The radial nerve runs on the top side of the forearm under the muscles, helping extend the wrist, bring your hand back, and provide sensation to the back side of your hand.
This nerve can become pinched in the muscles of the forearm, causing forearm pain 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.
You can use your arm about two weeks after surgery, but the incision may be sore for up to a few months.
The tibial nerve runs down the inside of your ankle and provides sensation to the bottom of the foot. When this nerve is compressed by soft tissue bands or anatomical variants, it’s called tarsal tunnel syndrome.
Tarsal tunnel syndrome causes 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 and 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 surgery, a bulky dressing is applied. You’ll be placed in a CAM boot and will use crutches, not placing any weight on the ankle.
Typically, patients are back to 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.