Operative & Non-Operative Peripheral Nerve Care

Median Nerve Entrapment – Carpal Tunnel Syndrome

The most predominant peripheral nerve problem is medial nerve entrapment, or carpal tunnel syndrome. Carpal tunnel syndrome occurs when the median nerve in the wrist becomes inflamed after being aggravated by repetitive movements such as typing on a computer keyboard. Over time, the repetitive movements can cause compression of the median nerve. Symptoms can include hand and wrist pain, a burning sensation in the middle and index fingers, thumb and finger numbness, and difficulty holding objects without dropping them.

Conservative (non-operative) Treatment Options: The main objective of conservative treatment is to reduce or eliminate repetitive injury to the median nerve. In some cases, this can be accomplished by immobilizing the wrist with a splint to minimize or stop pressure on the nerves. Patients may also be given hand and wrist exercises to complete both during and after work hours. If rest, splinting, and exercise are not successful, patients may also be prescribed anti-inflammatory medications or cortisone injections to reduce swelling.

If patients experience severe pain with persistent neurological symptoms that cannot be eliminated through conservative treatment options, surgery may be recommended to relieve the pressure on the median nerve. The most common procedure is called a carpal tunnel release, which involves the surgeon opening the wrist and cutting the ligament at the bottom of the wrist to relieve pressure.

Occipital Nerve Entrapment

Occipital nerve entrapment is a term used to describe pain originating from the base of the skull that often radiates to the back, side and front of the head, as well as behind the eyes. The occipital nerves are inflamed and sensitive because they are trapped within the muscles through which they pass.

Conservative (non-operative) treatment options: Treatment may include oral medications designed to reduce inflammation and spasms, localized therapeutic injections, and/or physical therapy.

Operative Treatment: If surgery is necessary, options include occipital neurectomy, occipital nerve block, C2 nerve root decompression, and joint stabilization.

Ulnar Nerve Entrapment

The ulnar nerve travels between the tip of the elbow and the inner elbow bone on the posterior portion of the elbow. The nerve can be pinched by normal or swollen structures after injury or following frequent elbow bending while pulling levers, reaching or lifting. Pain over the forearm, especially the inner side and numbness of the little and ring finger can be experienced.

Conservative (non-operative) treatment options: Treatment can include limiting elbow bending (i.e., the movement that is causing the pain), anti-inflammatory medications, patient education, and the use of elbow pads.

Operative Treatment: If surgery becomes necessary, an ulnar nerve release is performed, which simply removes the medial epicondyle on the inside edge of the elbow, releasing the pressure caused by the bony bump.