Common nerve decompressions of the upper extremity: reliable exposure using shorter incisions

Considering that several different specialties perform nerve decompressions in the upper extremity, universal technical standards do not exist. Many of these procedures are performed via incisions that are made unnecessarily long to achieve adequate exposure of the nerves and their known anatomical compression points. The purpose of this article is to introduce reproducible techniques that reliably allow the necessary anatomical exposure while minimizing the length of required skin incisions.

The senior author's surgical approach to the most common nerve compression syndromes of the upper extremity is presented in detail. Typical incision lengths and surgical exposure are demonstrated photographically. The safety of using this technique is examined by review of the medical records of all patients undergoing this procedure from 2003 to 2011, looking for technical complications such as unintentional damage to nerves or adjacent structures.

Three hundred twenty consecutive cases were identified in which the described techniques were used to release known anatomical compression points of the upper extremity nerves, including 161 decompressions of the ulnar nerve at the elbow, 37 decompressions of the anterior interosseous nerve and 45 of the posterior interosseous nerve in the proximal forearm, and 77 decompressions of the radial sensory nerve in the distal forearm. Typical incision lengths we used for these procedures were 5 cm for the ulnar nerve, 4.5 cm for the anterior interosseous nerve, 4 cm for the posterior interosseous nerve, and 3 cm for the radial sensory nerve. Review of medical records revealed no incidences of unintentional injury to nerves or adjacent important structures. Functional and neurological recovery outcomes were not assessed, as those would be the subject of subsequent studies.

Known anatomical compression points can be reliably accessed and decompressed for the treatment of all common upper extremity nerve compression syndromes using minimized skin incisions and the techniques presented in this article. With appropriate knowledge of anatomy, this can be performed without expensive equipment or any additional risk of injury to the patient, making classically described longer incisions unnecessarily morbid.