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May 2025 SURGICAL MANAGEMENT OF COMMON COMPRESSION NEUROPATHIESReading time: 2.5 minutes
Compression or entrapment neuropathies occur when a nerve is compressed or pinched by surrounding tissues, leading to pain, weakness and other symptoms. They are caused by various factors, including repetitive movement, trauma, systematic conditions, prolonged pressure and more. Below are some of the most common compression neuropathies. Diagnosis is made through a combination of physical examination and diagnostic studies such as electromyography (EMG) and nerve conduction studies (NCS). Take-home points Most common peripheral nerve conditions:
Carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the most common compressive neuropathy, affecting one in 1,000 people. It occurs when the median nerve is compressed at the wrist, leading to pain, weakness, numbness and tingling in the hand. Common causes include repetitive movements, pregnancy, diabetes and other inflammatory conditions. Initial treatment typically involves conservative measures, such as bracing, lifestyle modifications, physical therapy and sometimes 
Traditional open surgery for CTS (image on left) involves a lengthy recovery period because of the incision on the palm. This procedure can only be performed on one hand at a time to avoid further limiting mobility. It is contraindicated for many patients who require a walker or cane for ambulation, as constant pressure on the wound can delay healing or lead to complications.
Ultrasound-guided carpal tunnel release is minimally invasive (image on right) and significantly reduces healing time. This approach uses ultrasound guidance and a small incision, 3 to 4 mm in length, allowing for simultaneous treatment of both hands. This method is particularly beneficial for patients with limited mobility. No sutures are needed because of the small incision size. Ulnar neuropathy Ulnar neuropathy involves the compression or irritation of the ulnar nerve, primarily affecting the ring and pinky fingers due to compression at the elbow (cubital tunnel) or wrist (Guyon’s canal). Symptoms include numbness, tingling, weakness in the hand and pain. Causes include repetitive motion, trauma and prolonged pressure on the elbow or wrist. While conservative treatments like bracing and physical therapy are common, traditional surgical intervention remains necessary for severe cases. The standard surgical treatment is ulnar nerve decompression, with nerve transposition reserved for more complex cases. Although recovery is prolonged, patients can achieve positive outcomes. Peroneal neuropathy Peroneal neuropathy, often referred to as slimmer’s palsy, is caused by trauma, repetitive injury or rapid weight loss, leading to painless foot weakness. Treatment is largely supportive or surgical in nature. Unlike carpal tunnel syndrome and ulnar neuropathy, bracing helps with ambulation to prevent tripping, particularly when navigating stairs or uneven surfaces. For patients with compression of the peroneal nerve, nerve decompression surgery is the best treatment if conservative methods fail. About the author Kevin N. Swong, MD, a neurosurgeon at Northwestern Medicine, provides an overview of the latest advancements in the surgical management of peripheral nerve conditions. Dr. Swong is uniquely dual fellowship trained in both spine and peripheral nerve surgery, one of few specialists in the Midwest with this expertise. Dr. Swong runs the multidisciplinary clinic at Shirley Ryan AbilityLab, known as the C-Care Clinic. This clinic brings together experts in physiatry, plastic surgery and occupational therapy to provide comprehensive care for patients with complex peripheral nerve injuries and spinal cord injuries. |
Kevin N. Swong, MD, Assistant Professor, Neurological Surgery at Northwestern Medicine
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