Nerve decompression is a type of surgery performed to relieve pressure on a nerve. Certain types of nerves are more likely to be compressed due to their surrounding skeletal structure. The goal of nerve decompression surgery is to either create more space for the compressed nerve or to remove what is pressing on the nerve or sometimes both.

Peripheral nerve decompression surgery is for conditions that begin somewhere else other than the spine. They include:

• Carpal tunnel syndrome: This is characterized by the numbness of the first three fingers due to compression of the median nerve at the wrist.
• Cubital tunnel syndrome: This is numbness in the 4^th and 5^th fingers or general hand weakness due to compression of the ulnar nerve at the elbow.
• Radial nerve compression: This is pain with weakness in the forearm during finger extension due to compression of the radial nerve at the forearm.
• Thoracic outlet syndrome: This is the compression of the brachial plexus that affects arm circulation when the arm is elevated causing pain, numbness, or paresthesias.
• Peroneal nerve compression: This is characterized by numbness at the top of the foot and/or pain that gets worse during activities. Patients who have it usually have history of an ankle sprain or knee trauma.
• Tarsal tunnel or Tibial nerve syndrome: Bottom of the foot pain, numbness, or burning sensation due to nerve compression in the tibial and inner ankle. This is mostly common in diabetic patients.

Candidates for Peripheral Nerve Decompression Surgery

Individuals who are experiencing a combination of pain, burning sensation, numbness, or muscle weakness along the upper or lower extremity compression sites may have peripheral neuropathy.

Common causes for neuropathy apart from trauma or surgery include diabetes, hyperthyroidism, auto immune diseases, certain drugs and vitamin deficiencies. These underlying conditions should first be treated before considering peripheral nerve decompression surgery.

Peripheral nerve decompression surgery is for patients who have tried conservative treatments such as physical therapy and anti-inflammatory medication without relief. Before this procedure, a physician should conduct a work-up to help determine the cause and also exclude other non-peripheral nerve related conditions.

Procedure

Peripheral nerve decompression surgery is usually done under general anesthesia and most of the procedures are done on an outpatient basis. It involves a surgeon making a small incision in the skin above the anatomical nerve compression area. Once the compressed nerve is identified, the surgeon uses microsurgical instruments and techniques to incise the anatomical structures overlying the nerve (tunnels). This releases the tight fascial bands and tissues or vessels that are pressing on the nerves enabling normal function of the nerves.

Recovery

Recovery from peripheral nerve decompression surgery varies and can take about two-three weeks depending on various factors such as age, type of work that the patient does, co-morbidities, etc.

The dressings are usually removed a week after surgery and sutures three weeks after the procedure. Personal level discomfort usually determines if ambulation will be used during the recovery. The incisions are usually quite minimal which translates to quicker recovery and minimal risk of infection.

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