A surgical procedure that frees a peripheral nerve (such as the ulnar nerve at the cubital tunnel, the radial nerve at the radial tunnel, or the peroneal nerve) from compression in an anatomically narrow region, addressing numbness, pain and muscle weakness.
Indication
- Moderate-to-severe nerve compression confirmed by EMG (cubital tunnel syndrome, radial tunnel, peroneal nerve entrapment, etc.)
- Numbness, tingling and pain in the affected nerve distribution
- Weakness or early atrophy of the muscles supplied by the nerve
- Symptoms unresponsive to conservative treatment (splinting, physical therapy, NSAIDs, corticosteroid injection)
- Symptoms that interfere with sleep, daily living and work performance
- In cubital tunnel syndrome, symptoms triggered by prolonged elbow flexion beyond 90 degrees
Preparation
- Detailed neurological examination, EMG and, when needed, ultrasound or MRI to localise the compression site
- Optimisation of associated conditions (diabetes, hypothyroidism, B12 deficiency) before surgery
- Adjustment of blood-thinning medications under physician supervision
- Skin preparation and required preoperative blood tests
- Fasting for 6-8 hours when regional or general anaesthesia is planned
How it's performed
- Anaesthesia (local, regional or general) is administered according to the compression site
- A skin incision of appropriate length is made over the area of compression
- Fascial bands and ligaments overlying the nerve are released to free it from pressure (simple decompression)
- In selected cubital tunnel cases, the ulnar nerve is moved anteriorly (transposition) to prevent stretching during elbow flexion
- The integrity and free gliding of the nerve are confirmed
- The skin is closed with sutures and a splint or dressing is applied if needed
Post-procedure
- Day-case discharge or a one-night hospital stay depending on the site and extent of surgery
- Splint use for 1-3 weeks (especially to protect the elbow after cubital tunnel surgery)
- Suture removal at 10-14 days
- Physical therapy and nerve-gliding exercises for 4-8 weeks
- Return to light duties in 1-2 weeks and heavier work in 4-6 weeks; full nerve recovery may take months
Risks
- Infection (possible with any surgical procedure)
- Temporary or, rarely, permanent sensory loss or nerve injury
- Inadequate decompression or recurrent compression
- Wound pain, tenderness or scar formation
- Anaesthesia-related reactions
FAQ
Will my symptoms disappear completely after entrapment neuropathy surgery?
When decompression is performed in early stages, most symptoms can improve significantly. If muscle wasting has already developed, recovery may be incomplete; this is why early diagnosis and treatment are important.
Is the ulnar nerve always transposed in cubital tunnel syndrome?
This decision depends on the tension on the nerve and the surgeon's assessment. Transposition (anterior repositioning) is preferred when simple decompression is insufficient or when the nerve subluxes from its groove during elbow flexion.
How long does recovery take?
Skin healing takes 2-3 weeks. Nerves regenerate at roughly 1 mm per day, so full recovery may take 3-12 months depending on the site. Regular physical therapy speeds up the process.
Is physical therapy required after surgery?
Yes. A nerve-gliding and muscle-strengthening programme helps preserve nerve mobility and restore function. Physical therapy is an important component of a successful recovery.
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