Peripheral nerve decompression surgery is a specialized subfield of neurosurgery and orthopedic hand surgery focused on relieving anatomical compression along peripheral nerve pathways. The primary objectives are to alleviate mechanical pressure, restore neural blood flow (microvascular perfusion), prevent irreversible nerve degeneration, and restore upper extremity sensation and motor function. Treatment strategies vary depending on the specific nerve involved—most commonly the median nerve at the wrist (carpal tunnel syndrome) or the ulnar nerve at the elbow (cubital tunnel syndrome) or wrist (Guyon's canal syndrome).

The patient is positioned supine with the arm extended on an armboard. Following skin preparation and sterile draping, local or regional anesthesia is administered. For carpal tunnel release, a longitudinal incision is made over the flexor retinaculum, or endoscopic portals are established. The transverse carpal ligament is divided completely under direct visualization to decompress the median nerve. For ulnar nerve decompression at the elbow, an incision is made posterior to the medial epicondyle to divide Osborne's ligament and the flexor carpi ulnaris fascia. If the nerve is unstable or severely compressed, an anterior transposition (subcutaneous, submuscular, or intermuscular) or medial epicondylectomy is performed. Hemostasis is achieved, the nerve is inspected to ensure complete release, and wounds are closed in layers using fine sutures before applying a bulky protective dressing.

Evidence-based clinical advantages of peripheral nerve decompression include significant reduction in nighttime and daytime paresthesias, pain relief, improved grip and pinch strength, and prevention of irreversible intrinsic muscle wasting. Surgical decompression demonstrates superior long-term clinical outcomes compared to continued conservative management in patients with moderate-to-severe electrochemically confirmed nerve entrapment (AAOS Clinical Practice Guidelines, 2016; ASSH Evidence-Based Practice Committee, 2021).

Initial recovery occurs over 10 to 14 days, during which surgical incisions heal and sutures are removed. Light daily activities can typically be resumed within 1 to 2 weeks. Full return to heavy manual labor, forceful gripping, or athletic activities generally requires 6 to 12 weeks, depending on whether simple decompression or complex nerve transposition was performed. Complete nerve recovery and maximal muscle strength restoration may continue for up to 12 to 18 months postoperatively.

Peripheral nerve surgery treats entrapment neuropathies of the upper limb. Indications include severe or progressive carpal tunnel syndrome (median nerve entrapment), cubital tunnel syndrome (ulnar nerve compression at the elbow), Guyon's canal syndrome (ulnar nerve compression at the wrist), recurrent or persistent entrapment following prior surgical release, and peripheral nerve trauma requiring neurolysis or nerve grafting.

Preoperative preparation includes physical examination, electrodiagnostic testing (electromyography and nerve conduction velocity studies), and imaging when indicated (ultrasound or MRI). Patients are instructed to discontinue nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners under physician guidance. Fasting guidelines are provided based on the planned anesthesia technique (local, regional, or general). Hand therapy preoperative education is provided regarding post-procedure splinting and wound care instructions.

Minor complications include surgical site soreness, scar tenderness (pillar pain), temporary wound swelling, and superficial infection. Moderate risks include nerve stiffness, persistent paresthesia, hematoma, and delayed wound healing. Severe but rare complications include transection or injury to the main median or ulnar nerve branches, palmar cutaneous nerve injury, complex regional pain syndrome (CRPS), deep infection, and recurrent nerve compression due to scar formation.

The patient journey begins with an initial clinical evaluation involving diagnostic nerve conduction studies and physical examination. Preoperative preparation includes medication adjustments and surgical site marking. The procedure is performed under local, regional, or general anesthesia as an outpatient operation lasting 30 to 60 minutes. Immediate recovery involves monitoring in a post-anesthesia care unit followed by discharge the same day with a protective dressing or splint. Postoperative care includes structured hand therapy, wound care, and scheduled follow-up visits at two weeks for suture removal and functional evaluation over 3 to 12 months.