Peripheral Procedures

Peripheral Procedures

Treatments and Procedures

At Northern Neurosurgery and Spine, patients and health care providers are able to learn about spine anatomy, different spinal conditions, and the vast array of traditional and minimally invasive treatment options. We offer a full spectrum of spine information, ranging from simple, basic descriptions to up-to-date information from recent medical journal articles, so that you may learn as much as possible about the spine.

Carpal Tunnel Release

Carpal tunnel syndrome is a common, painful condition of the hand and fingers caused by compression of a major nerve where it passes over the carpal bones through a passage at the front of the wrist, alongside the flexor tendons of the hand. It may be caused by repetitive movements over a long period, or by fluid retention, and is characterized by sensations of tingling, numbness, or burning.

The surgery is performed at the surgery center under local anesthetic with sedation.  It typically takes about 30 minutes.  Your hand will be wrapped in a bandage that will stay in place for 4 days.  Once removed, you will need to wash your hand several times a day with soap and water.  Sutures will be removed at 10-14 days post surgery.

• Minimize activity on the day of surgery.
• Elevate the surgical hand and apply an ice pack every hour for 20 minutes, for the first 48 hours. After that, elevate and apply ice 2-3 times/day until the swelling goes down. Place a thin towel between the ice bag and your skin. Do NOT use heat.
• Once the initial surgical dressing is removed, you may use the hand and wrist as tolerated for light activity. You are encouraged to bend the wrist, elbow and fingers as soon as the initial surgical dressing is removed.
• Avoid lifting, pushing, or pulling any object greater than 5-10 pounds for the first 10-14 days. Do not use exercise equipment until your doctor allows you to do so.

Ulnar Nerve Decompression

Ulnar nerve decompression is surgical procedure designed to explore the region around the elbow through which the ulnar nerve passes. The ulnar nerve is responsible for the “funny bone” phenomenon when you hit your elbow. The ulnar nerve can become compressed at the elbow.  People can experience pain, numbness/tingling and weakness of the hand.  The diagnosis is confirmed by EMG/NCS.

The procedure is performed under monitored and local anesthesia at the surgery center and typically takes about an hour. The surgery will take less than one hour. There are two surgical techniques your surgeon may use – a traditional open surgery or a minimally invasive endoscopic variation. The goal of both is to increase the size of the cubital tunnel and relieve pressure on the ulnar nerve.

Overall recovery time varies by individual. It can take at least 2-3 months before you start to regain normal use of the extremity. Physical therapy is often needed and starts six weeks after surgery. Improvement in the numbness can be immediate, but in some patients, it can take months to get better.

Peroneal Nerve Decompression

The peroneal nerve is on the outside of the leg, just below the knee.  It is subject to injury with fractures, but can become compressed with tissue.  Patients typically present with weakness in their foot and often catch their toe.  This issue can arise with pinched nerves in the lumbar region as well, but a peroneal neuropathy typically does not cause pain down the leg.  An EMG/NCS is utilized to diagnose the problem.

With the patients in the lateral position and the side of the lesion uppermost, we performed microsurgical decompression of the affected common peroneal nerve (CPN) under local anesthesia and typically takes about an hour.

The incision is closed with absorbable suture and glue. A soft compression dressing is applied. Patients are allowed to weight-bear as tolerated. Assistive devices are offered to patients post-operatively but typically are not needed. Patients are instructed to avoid unnecessary ambulation and elevate the leg as much as possible during the first three weeks post-operatively. This will help limit swelling of the lower extremity and any issues with wound healing. Diabetic and obese patients may require additional interrupted nylon sutures to support their incision. These are removed at two weeks post-operatively. At three weeks post-operatively, patients may be referred to physical therapy to address any issues with edema, scar, ankle ROM, strength and ambulation. At two months post-operatively, they are typically released to all activities.