Peripheral neuropathy describes damage to the peripheral nervous system, the network of nerves outside of the brain and spinal cord that transmits signals between the central nervous system and the rest of the body. This damage can lead to symptoms like pain, numbness, tingling, or muscle weakness, most often in the hands and feet. Common causes include systemic diseases like diabetes, chemotherapy exposure, and physical factors such as trauma or nerve compression. Surgery is an option for neuropathy, but it is specifically reserved for cases where the nerve damage is caused by a physical obstruction or injury, rather than a systemic illness.
When Surgery Becomes an Option
Surgical intervention is generally considered only after a thorough diagnostic process confirms the neuropathy is due to a physical cause, rather than a disease affecting the entire body. Systemic conditions like diabetic neuropathy are primarily managed through medical treatments such as blood sugar control, lifestyle adjustments, and pain-relieving medications. However, a significant portion of patients with systemic neuropathy, including an estimated 30–60% of those with diabetic neuropathy, also have a component of nerve compression that can be addressed surgically.
Surgery is primarily indicated for two specific categories: compressive neuropathies and traumatic nerve injuries. Compressive neuropathies, also known as entrapment syndromes, occur when a nerve is physically squeezed by surrounding tissue, bone, or tendon as it passes through a narrow anatomical space. Common examples include carpal tunnel syndrome in the wrist or tarsal tunnel syndrome in the ankle.
The diagnostic workup for surgical candidacy typically involves specific tests to pinpoint the nature and location of the damage. Nerve conduction studies (NCS) and electromyography (EMG) are used to measure the electrical activity of the nerves and muscles to determine how well a nerve is functioning. Imaging, such as specialized ultrasound or MRI, can also help visualize the nerve and identify any physical compression or injury.
Before moving to surgery, the standard approach is to first exhaust non-surgical treatments. These conservative measures may include physical therapy, splinting or bracing to limit movement, or steroid injections to reduce inflammation around the nerve. Surgical consideration only moves forward when these methods fail to provide adequate relief or when the nerve damage is severe and progressive, leading to significant muscle weakness or atrophy.
Procedures for Nerve Decompression and Repair
The surgical strategies employed for neuropathy depend entirely on the underlying cause—whether the nerve is compressed or physically severed. The two main types of procedures are decompression and nerve repair or grafting. Nerve decompression, or neurolysis, is the intervention used for entrapment neuropathies.
During a decompression procedure, the surgeon carefully makes an incision to access the area where the nerve is restricted. The goal is to release the constricting structures, such as tight fascial bands, ligaments, or scar tissue, that are pressing on the nerve. This release allows the nerve to “breathe,” restoring blood flow and relieving the pressure that caused the pain and function loss. A common example is a Carpal Tunnel Release, where the transverse carpal ligament is cut to create more space for the median nerve.
For a nerve that has been physically cut or severely damaged by trauma, the procedure shifts to nerve repair or nerve grafting. If the nerve ends are clean and can be brought together without tension, the surgeon performs a direct repair, called neurorrhaphy, by precisely suturing the ends together. When there is a gap or a segment of nerve is missing, direct repair is impossible. In cases with a significant gap, the surgeon will perform a nerve graft, which involves bridging the distance with a piece of nerve tissue. The gold standard is an autograft, which uses a piece of less-critical sensory nerve harvested from another part of the patient’s own body.
Managing Recovery and Outcomes
Recovery following nerve surgery is a process that requires patience, as nerve regeneration occurs at a slow and predictable pace. Nerves typically regrow at a rate of approximately one inch per month, meaning a full return of function and sensation can take many months to over a year, depending on the distance from the repair site to the target muscle or skin. While some patients report an immediate decrease in pain, the restoration of sensation and muscle strength is gradual.
Post-surgical care includes pain management for the incision site and often requires the use of a brace or splint to protect the repair. Physical or occupational therapy is a mandatory and integrated part of the recovery phase. Therapists work with the patient to maintain joint flexibility and gradually strengthen muscles that were weakened due to the nerve damage, which is crucial for maximizing the functional outcome.
It is important for patients to maintain realistic expectations regarding the outcome of the procedure. While surgery can significantly relieve pain and improve function, it does not guarantee a complete return to 100% pre-injury status. Success rates for nerve decompression in properly selected patients are often high, with reports showing significant pain reduction and improved sensation. However, if the nerve damage was long-standing or particularly severe before the intervention, some residual deficits may persist.