What is Nerve Decompression of the Upper Extremities?
Nerve decompression of the upper extremities, also called peripheral nerve decompression, is a minimally invasive surgical procedure employed to relieve pressure on an entrapped or pinched nerve (neuroma) for the treatment of conditions such as carpal tunnel syndrome and cubital tunnel syndrome, the two most common nerve compression syndromes.
Carpal tunnel syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.
Cubital tunnel syndrome, also called ulnar nerve entrapment, is a condition caused by compression of the ulnar nerve in an area of the elbow called the cubital tunnel.
A nerve in the upper extremities may become compressed due to surrounding soft-tissue or skeletal structures which causes narrowing of space through which the nerve passes. The objective of the nerve decompression surgery is to remove these structures causing nerve compression or open up any narrow spaces to provide more room to the nerve, or both.
Indications for Nerve Decompression
Nerve decompression surgery is recommended for patients suffering from symptoms of compressed nerves such as pain, stiffness, numbness, tingling sensation, and/or functional loss who have not had relief through other conservative treatment measures such as the use of braces or splints, medications, and occupational therapy. Nerve decompression surgery is also recommended as an alternative to complete removal of the neuroma.
Nerve decompression is mainly indicated for the treatment of upper extremity nerve compression syndromes such as:
- Carpal tunnel syndrome
- Cubital tunnel syndrome
- Posterior interosseous syndrome
- Radial tunnel syndrome
Preparation for Nerve Decompression
Preoperative preparation for nerve decompression surgery will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a week prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Nerve Decompression
Most nerve decompression surgeries of the upper extremities are performed endoscopically in a minimally invasive outpatient setting and take about an hour. Endoscopic refers to the surgery being performed utilising an endoscope - a thin, flexible fibre-optic tube with a camera, light, magnifying lens, and a port to pass tiny surgical instruments.
In general, nerve decompression surgery involves the following steps:
- General or local anaesthesia is administered to the patient.
- Your surgeon first locates the affected nerve site and cleans the surgical area with an antibacterial solution.
- A small 2 cm incision is made along the surgical site requiring nerve decompression.
- Surgical tools called retractors are used to separate the edges of the incision and draw back superficial nerves from the affected nerve (ulnar or median nerve).
- Your surgeon then inserts an endoscope to examine the condition of the nerve and its surrounding structures.
- The camera attached to the endoscope is connected to an external video monitor in the operating room and the scope displays surrounding structures of the nerve on the video monitor for your surgeon to view.
- Your surgeon passes miniature surgical instruments through the endoscope while looking at the monitor and cuts tight tunnels or structures around the nerve to relieve the pressure on the affected nerve (decompression).
- This provides more space for the nerve to move freely and to increase blood flow to promote healing of the affected nerve instead of completely removing the swollen nerve.
- Your surgeon then manipulates the upper extremity in different directions to evaluate the stability of the nerve.
- After confirming adequate decompression, the overlying soft tissue and skin are closed with sutures and sterile bandages are applied.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after nerve decompression will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover.
- Most patients will be discharged the same day of the surgery, however, some may require an overnight hospital stay.
- You may notice some pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- You will be placed in a sling for the first few days with instructions on restricted activities.
- You are advised to keep your arm elevated above your chest for a day or two while resting to prevent swelling and pain.
- You may be advised to wear a splint on the elbow or wrist area for a couple of weeks to help the area heal.
- You are encouraged to gently exercise your fingers, elbow, and shoulder to prevent stiffness.
- Application of ice packs on the operated area is also advised to prevent stiffness and swelling.
- Physical therapy and range of motion exercises are recommended to restore mobility and strengthen joints and muscles.
- You should keep your surgical site clean and dry for at least 48 hours. Instructions on surgical site care and bathing will be provided.
- Refrain from strenuous activities or lifting heavy objects for at least a couple of months. Gradual increase in activities over a period of time is recommended.
- Majority of the patients are able to resume most of their normal activities within a week.
- Do not drive until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Nerve decompression of the upper extremity is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Injury to nerves or vessels
- Anaesthetic/allergic reactions
- Elbow instability/stiffness
- Persistence or recurrence of compressed nerve symptoms
- Need for additional surgery