Entrapments neuropathies usually occur where the nerve courses through fibro-osseous or fibromuscular tunnels, more frequently in the upper extremity than in lower limb.
These compression neuropathies cause sensory disturbance, motor dysfunction and pain, which strongly affect quality of life.
Most of the time, conservative therapy is tried as first line treatment, followed by surgical decompression if symptoms persist. Balancing the potential of spontaneous recovery on one side, and on the other side the adverse physiopathological changes occurring with chronic compression, most authors advocate between 3 and 12 months of conservative management.
Delays in surgery, extending nerve compression time and therefore potentially irreversible pathophysiological changes, may decrease neurolysis efficiency. Unfortunately, no general consensus exists on a critical time limit that would make surgery worthwhile.
This prospective study aims to investigate whether or not late nerve decompression (more than twelve months after occurrence of clear symptoms, most often both sensory and motor, with surgical indication) has a positive impact on patient’s symptoms, despite acknowledgement of physical changes that occur in the nerve.
We focused our attention on the most common peripheral compression mononeuropathies, namely median and ulnar nerves, lateral femoral cutaneous (LFCN) and common peroneal nerves (CPN), including in total 28 patients with late neurolysis were involved. We performed complete sensory, provocative and motor testing for each selected nerve. Subjective pain and impact of neuropathy on daily life were investigated pre-operatively, at 3, 6 and 12 months follow-up. Data were analysed statistically and outcomes were critically analysed.
Our results confirms that late neurolysis is worthy, with favourable impact on quality of life, symptoms and functional potential. As a conclusion, we recommend proceeding neurolysis even in long standing nerve compression.