Peripheral Nerve Surgery

Peripheral nerves are the “cable” structures outside the brain and spinal cord. Entrapment neuropathies (compression within a canal), injuries and nerve sheath tumours can cause numbness and tingling, loss of strength and pain. Assessment is made by clinical examination together with EMG, supported by ultrasound/MRI if needed. Treatment is step by step and planned individually, from conservative methods to microsurgical decompression and reconstruction.

Carpal Tunnel Syndrome

Compression of the median nerve in the carpal tunnel at the wrist

Symptoms & Signs

• Numbness/tingling in the thumb, index and middle fingers (worse at night, relieved by shaking the hand)
• Reduced grip strength, frequently dropping things; in advanced stages, wasting of the thenar muscles
• Provocation tests: Phalen, Tinel

Diagnosis

• Clinical examination + EMG (the gold standard) showing slowed nerve conduction
• Ultrasound: if thickening within the canal / flexor tenosynovitis is suspected

Causes & Risks

• Repetitive hand and wrist movements, vibrating tools
• Diabetes, hypothyroidism, rheumatic diseases, pregnancy/oedema

Treatment Steps

• Conservative: night splint, ergonomic adjustments, pain management; in selected cases a local steroid injection
• Indications for surgery: moderate to severe EMG findings, thenar atrophy, no response within 8–12 weeks
• Micro-decompression: cutting the transverse carpal ligament through an open mini incision or with an endoscopic technique

Surgery & Recovery

• Usually under local anaesthesia, ≈10–20 min; discharged the same day
• In the first week, hand hygiene and brief rest; strengthening exercises in weeks 1–3
• In cases operated on early, night-time numbness decreases quickly; full strength in 3–6 weeks

Frequently Asked Questions

• Both hands at once? In the same session or at intervals; planned according to your occupation and comfort.
• Can it come back? This is rare; managing oedema/tenosynovitis and ergonomics is important.

Note: Treatment is individualised when there are accompanying conditions such as diabetes or thyroid disease.

Cubital Tunnel Syndrome

Compression of the ulnar nerve in its passage at the elbow

Symptoms & Signs

• Numbness in the ring and little fingers; weakness in the 4th–5th fingers
• Night-time symptoms that worsen with keeping the elbow bent for long periods or lying on it

Diagnosis

• Clinical examination + EMG (conduction block at the elbow segment)
• Ultrasound/MRI: if nerve subluxation or a narrow passage is suspected

Treatment

• Conservative: night elbow splint (≈30–45°), ergonomics, pain control
• Surgery: in-situ decompression (most cases) or anterior transposition (subluxation/narrow canal)

Surgery & Recovery

• Day case; stitches are removed at 10–14 days
• Sensory symptoms decrease within weeks; fine motor function recovers in 4–8 weeks

It may be necessary to avoid prolonged bent positions and to limit activities that strain the nerve.

Peroneal Nerve Entrapment Neuropathy

Nerve compression at the head of the fibula on the outer side of the knee

Symptoms & Signs

• Foot drop, tripping when walking; numbness on the top of the foot
• A history of crossing the legs, rapid weight loss or injury

Diagnosis

• EMG/NCS to determine the site and severity of the lesion; MRI/ultrasound if needed
• Differential diagnosis: L5 radiculopathy, proximal nerve injuries

Treatment

• Conservative: orthosis (AFO), physiotherapy and strengthening; avoiding habits that cause pressure
• Surgical decompression: in persistent conduction block/progressive loss of strength

Recovery

• Early decompression speeds up functional recovery; nerve regeneration may take weeks to months
• Rehabilitation and use of an appropriate orthosis help prevent falls

After injury with complete nerve division, advanced reconstruction options such as grafts/transfers are considered.