Typical Questions

What is the Relationship Neuropathy and Nerve Compression?

What Type of Surgery Can Be Done?

How Does This Type of Surgery Help the Hand?

Who is a Canididate for This Surgery?

How Long Does the Surgery Take?

Is the Surgery Painful?

Do I Have to be Hospitalized?

What are the Risks of This Surgery?

What are the Chances of Success?

The most common form of nerve problem in the diabetic is diabetic neuropathy. The symptoms of the most common type are numbness, tingling, and weakness. Diabetes creates the neuropathy according to a metabolic process. This neuropathy, then, creates the circumstances that allow nerve compression to occur.

Surgery that is well-known to restore sensation and strength to people with nerve compression, like carpal tunnel syndrome, can be done in patients with diabetes. Surgery to decompress the carpal tunnel is among the most common operations done in the United States. This type of surgery can be done in the arm, the hand, the leg, and the foot. The surgery opens the tight area through which the nerve passes by dividing a ligament or fibrous band that crosses the nerve. This gives the nerve more room, allows blood to flow better in the nerve, and permits the nerve to glide with movements of nearby joints.

The surgery to decompress the nerve does not change the basic, underlying metabolic (diabetic) neuropathy that made the nerve susceptible to compression in the first place. When the surgical decompression is done early in the course of nerve compression, restoration of blood flow to the nerve will stop the numbness and tingling, and permit strength to recover. When the decompression is done later in the course of nerve compression, and nerve fibers have begun to die, decompression of the nerve will permit the diabetic nerve to regenerate. If you wait too long to decompress the nerve, recovery may not be possible. If you already have ulcerations on your feet, or have lost toes, then very little sensation may be recovered because the damage to the nerve may have become irreversible

The ideal candidate for surgery to restore sensation and strength is the diabetic who is beginning to experience numbness and tingling in the hands or feet and who may have noticed weakness, loss of balance or loss of control of some of the muscles in the hands or feet. This patient should be examined in order to measure the degree of sensory and motor loss. The ideal candidate does not wait until there is no feeling left or until there is already an ulceration present. The ideal candidate seeks surgical consultation while there is still time to reverse the damage to the nerves.

From the time you enter the operating room until the time you enter the recovery room is about two hours. You will stay in the recovery room for another hour. These times will vary for individual patients.

No surgery is pain free but this surgery is not usually very painful. Partly, this is because you already have lost some of your sensation and partly it is because the surgery does not go into the joints. The surgery usually involves just cutting the skin and some ligaments and this usually is not too painful. A long-acting local anesthetic will be put into your incisions so that when you awake not only will there be very little pain but, in fact, you will not feel your hand or foot at all. When the local anesthetic wears off, in about four hours, you will begin to feel your hand or foot. If this becomes painful for you, you will be given pain medication for a few weeks after surgery. When the nerves that have been “asleep” awaken,you may experience hot or cold or shooting pains in your fingers or toes. This is a good sign as it shows recovery, but it may still be uncomfortable for you. There is medication that can help these feelings, too.

Most patients can have the surgery safely as an outpatient. There may be medical reasons why it will be best and safer for you to stay one night in the hospital, such as to receive intravenous antibiotics or to receive proper care for your heart or kidneys.

Although very rare, severe complications are possible. This is why your past medical history is so important to us in selecting the safest anesthesia for your surgery and in selecting the appropriate type of medical facility in which you should have your surgery.

Over the past 15 years, the results of this type of surgery have been carefully evaluated. Four separate studies have been done and reported between 1992 and 2000. These studies reached the same conclusion: Overall about 80 percent of those diabetic patients who have had nerve decompressed have had decreased pain and improved sensory and motor function. Balance is improved.