eMedicine Specialties > Neurosurgery > Miscellaneous

Nerve Entrapment Syndromes: Follow-up

Author: Amgad Saddik Hanna, MD, Assistant Professor, Department of Neurosurgery, University of Wisconsin, Madison
Coauthor(s): James S Harrop, MD, Associate Professor, Departments of Neurological and Orthopedic Surgery, Jefferson Medical College; Dachling Pang, MD, FRCS(C), FACS, Clinical Professor of Neurosurgery, Chief of Pediatric Neurosurgery, University of California Davis School of Medicine; Chief, Regional Center for Pediatric Neurosurgery, Kaiser Permanente Hospitals of Northern California; Kamran Sahrakar, MD, FACS, Clinical Professor, Department of Neurosurgery, University of California at San Francisco; Robert J Spinner, MD, Professor of Anatomy, Neurosurgery, and Orthopedics, College of Medicine, Mayo Clinic; Co-Director, Brachial Plexus Clinic, Consultant, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
Contributor Information and Disclosures

Updated: Jul 31, 2009

Outcome and Prognosis

In general, surgical outcomes are excellent in primary cases for improvement of pain and function. In secondary cases, results are fair to good; in these situations, pain relief is often the goal.

Carpal tunnel syndrome


Surgery is associated with a 70-90% rate of improvement of median nerve-related symptoms.24

The most common potential complications include the following:

  • Misdiagnosis
  • Incomplete sectioning of the TCL
  • Palmar pain
  • Pillar pain along the thenar and hypothenar eminences (probably related to adjustment of the carpal bone alignments)
  • Temporary loss of grip strength secondary to relocation of the origin of the hypothenar and thenar muscles and bowing of the flexor tendons through the TCL incision

Most of these complications are transient. Neurovascular complications can rarely occur and have been reported with open and endoscopic techniques. Neural injury may affect the median and ulnar nerves, digital nerves (or communicating branches), cutaneous branches, and the recurrent motor branch and vascular injury, to the superficial palmar arch or ulnar artery.

Postoperative infection is reported in approximately 0-5% of patients. Palmar space infection is an extremely serious emergency that can result in permanent adhesive tenosynovitis and recurrent median nerve compression. Open drainage, use of a drain, and high-dose intravenous antibiotics should be instituted immediately.

Ulnar nerve compression at the elbow

Adherence to strict surgical principles results in a good outcome in approximately 80% of patients regardless of the procedure chosen. Surgical failure may be due to inadequate decompression or secondary compression of the ulnar nerve. One should also consider the possibility of a neuroma of the medial antebrachial cutaneous nerve in a patient with medial, volar forearm pain following previous ulnar nerve surgery. Revision ulnar nerve surgery most commonly employs a submuscular transposition, although this technique is by far the most complex and difficult to perfect.

Posterior interosseous nerve syndrome

Good to excellent outcomes are often achieved in these patients following spontaneous recovery or decompression.

Suprascapular nerve entrapment

Symptomatic improvement is frequently seen in patients who undergo decompression. Often this may be seen within days of the surgery, especially with respect to external rotation. However, long-term weakness and atrophy may take many months to improve, and some patients never regain full strength. Early detection is an important predictor of outcome in suprascapular entrapment.

Ulnar nerve compression at the wrist

Improvement is expected in the painful cases and in those with mild motor loss. In some cases, severe atrophy may improve due to the relative short distances for reinnervation from the site of compression to the muscle end-plate. Long-standing atrophy likely will not improve. 

Meralgia paresthetica

Surgical decompression is very effective, but the recurrence rate is 15-20%.

Tarsal tunnel syndrome

In general, 75% of patients enjoy significant improvement with surgical decompression of the tarsal tunnel. The best surgical results are observed in patients with mass lesions within the tunnel; the worst results are observed in patients who have undergone previous exploration for pain and those with plantar fasciitis and autoimmune diseases.

Future and Controversies

In the future, further advances will be made related to the diagnosis and management (ie, surgical outcomes) of common and uncommon entrapment neuropathies, not to mention certain pain syndromes (ie, radial tunnel, pronator and piriformis syndrome,25,26 pudendal nerve entrapment) and other types of neuropathies (eg, diabetes11 ) in which entrapment has been postulated to play a role. Hopefully, answers to these questions will allow new controversies to emerge.

 


More on Nerve Entrapment Syndromes

Overview: Nerve Entrapment Syndromes
Workup: Nerve Entrapment Syndromes
Treatment: Nerve Entrapment Syndromes
Follow-up: Nerve Entrapment Syndromes
Multimedia: Nerve Entrapment Syndromes
References
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References

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Further Reading

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Keywords

nerve entrapment syndromes, nerve entrapment syndrome, nerve entrapment, nerve compression, chronic nerve injury, entrapment, carpal tunnel, cubital tunnel, meralgia paresthetica, decompression, nerve decompression, nerve entrapment, entrapment neuropathies, chronic compression, carpal tunnel syndrome, posterior interosseous nerve syndrome, PIN, suprascapular nerve entrapment, tarsal tunnel syndrome

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Contributor Information and Disclosures

Author

Amgad Saddik Hanna, MD, Assistant Professor, Department of Neurosurgery, University of Wisconsin, Madison
Amgad Saddik Hanna, MD is a member of the following medical societies: American Association of Neurological Surgeons, Central Neuropsychiatric Association, and Congress of Neurological Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

James S Harrop, MD, Associate Professor, Departments of Neurological and Orthopedic Surgery, Jefferson Medical College
James S Harrop, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Spinal Injury Association, Cervical Spine Research Society, Congress of Neurological Surgeons, and North American Spine Society
Disclosure: Depuy spine Consulting fee Consulting; Medtronic Consulting fee Consulting; stryker spine Honoraria Speaking and teaching

Dachling Pang, MD, FRCS(C), FACS, Clinical Professor of Neurosurgery, Chief of Pediatric Neurosurgery, University of California Davis School of Medicine; Chief, Regional Center for Pediatric Neurosurgery, Kaiser Permanente Hospitals of Northern California
Dachling Pang, MD, FRCS(C), FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, Congress of Neurological Surgeons, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Kamran Sahrakar, MD, FACS, Clinical Professor, Department of Neurosurgery, University of California at San Francisco
Kamran Sahrakar, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Medical Association, California Medical Association, Florida Medical Association, and Nevada State Medical Association
Disclosure: Nothing to disclose.

Robert J Spinner, MD, Professor of Anatomy, Neurosurgery, and Orthopedics, College of Medicine, Mayo Clinic; Co-Director, Brachial Plexus Clinic, Consultant, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
Robert J Spinner, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Association for the Advancement of Science, American Association of Clinical Anatomists, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Association, Congress of Neurological Surgeons, and Congress of Neurological Surgeons
Disclosure: Mayo Medical Ventures Consulting fee Consulting

Medical Editor

Michael G Nosko, MD, PhD, Chief, Division of Neurosurgery, Director of Neurovascular Surgery, Medical Director of Neuroscience Unit, Associate Professor, Department of Surgery, University of Medicine and Dentistry of New Jersey
Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, New York Academy of Sciences, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ryszard M Pluta, MD, PhD, Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences at Warsaw, Poland; Senior Researcher, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH
Ryszard M Pluta, MD, PhD is a member of the following medical societies: Congress of Neurological Surgeons and Polish Society of Neurosurgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

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