Peripheral Nerve Surgery
Entrapment neuropathies such as carpal tunnel syndrome, traumatic nerve injuries and nerve repair — addressed with microsurgical techniques and regenerative support approaches.
The Peripheral Nervous System and Why Timely Care Matters
Peripheral nerves are the living communication lines that branch out from the brain and spinal cord, carrying movement commands to your muscles and returning sensations of touch, temperature and pain from the skin. When a nerve is compressed or injured, symptoms such as numbness, tingling, weakness or a burning pain can appear. These complaints often begin subtly and progress over time.
Nerve tissue heals on its own particular schedule; damaged fibres regrow at roughly one millimetre per day. This is precisely why the timing of diagnosis directly shapes the outcome. A nerve left compressed for too long, or whose repair is delayed, allows its target muscle to waste in a way that becomes progressively harder to reverse.
Early evaluation is the most reliable way to reduce the risk of permanent muscle loss and sensory disturbance. A detailed neurological examination, electromyography (EMG) and, when needed, ultrasound or MRI clarify the location and severity of the problem. The goal is to understand which nerve is affected, to what degree and why, and to build a treatment plan tailored to you.
Entrapment Neuropathies and Carpal Tunnel Syndrome
An entrapment neuropathy develops when a nerve is subjected to persistent pressure as it passes through a narrow anatomical channel. The most common is carpal tunnel syndrome, in which the median nerve is compressed at the wrist. Numbness in the thumb, index and middle fingers, night-time tingling that wakes you, and clumsiness of the hand are the typical complaints.
Compression of the ulnar nerve at the elbow (cubital tunnel) instead causes numbness in the little and ring fingers and, in advanced cases, weakness of the small hand muscles. Many of these syndromes are linked to contributing factors such as repetitive movements, thyroid disease, diabetes or pregnancy, and are clarified through a careful history.
In early stages, splinting, activity modification and sometimes injections can bring relief. When symptoms progress or EMG shows clear nerve damage, a surgical release is performed to relieve the compressed segment. This is usually a short, low-risk procedure and, when carried out at the right time, achieves marked improvement in the great majority of patients.
Traumatic Nerve Injuries
Lacerations, fractures, crush injuries, overstretching and gunshot wounds can all damage peripheral nerves. The severity ranges from a nerve that has only temporarily lost its ability to conduct (neurapraxia) to complete disruption of the fibres or the nerve trunk itself (axonotmesis, neurotmesis). This distinction is the single most important factor guiding treatment.
Symptoms depend on the nerve involved: a sudden loss of strength or sensation in a specific region of the arm or hand, drooping of a limb, or intolerable pain may occur. Brachial plexus injuries sustained during birth, and radial nerve damage accompanying arm fractures, are among the special situations that require close monitoring.
While some injuries recover spontaneously, a completely severed nerve requires surgical repair. Timing is critical; sharp, clean cuts are ideally repaired early, whereas crush-type injuries are observed for a period to gauge their recovery potential. EMG and serial examinations help strike the right balance between watchful waiting and operating.
Microsurgical Nerve Repair Techniques
Nerve repair is a precise microsurgical discipline performed under the operating microscope with sutures finer than a human hair. In the simplest case, nerve ends that can be brought together without tension are joined directly (coaptation). The aim is to provide the regrowing fibres with a clean pathway so they can reach the correct targets.
When there is a gap and the ends cannot be joined without tension, a nerve graft is used to bridge the space; this graft is usually prepared from an expendable sensory nerve taken from the patient's own body. Alternatively, nerve tubes (conduits) or nerve transfers, which reroute a branch from a functionless nerve to a healthy one, may be employed.
The choice of technique reflects the location of the injury, the length of the gap, the time elapsed and the condition of the target muscle. Microsurgical repair prepares the best possible ground for healing; yet the result is ultimately set by the slow, natural pace at which nerve fibres grow. For this reason, repair is planned hand in hand with patient rehabilitation.
Regenerative Support for Nerve Healing
Regenerative medicine approaches that aim to accelerate nerve healing and improve its quality are an exciting frontier of current research. Mesenchymal stem cells (MSCs) and the exosomes they release are being studied because, in laboratory and early clinical work, they appear to carry signals that temper inflammation, support the nerve's sheath cells and create an environment favourable to regeneration.
Studies in which Prof. Dr. Erdinç Civelek has taken part, such as pioneering pilot work on radial nerve recovery, reflect this scientific curiosity. Such applications are considered supportive strategies hoped to complement, rather than replace, surgical repair, and they continue to be investigated with rigour.
An honest framing matters: regenerative support is not yet a standard, guaranteed treatment, and its effectiveness is still maturing through evidence-based studies. These options are considered only in suitable patients, with realistic expectations and in keeping with ethical and scientific principles. A proven foundation of surgery and rehabilitation always takes priority.
Recovery, Rehabilitation and Expectations
Nerve healing is a marathon, not a sprint. Because repaired fibres advance towards their target at roughly one millimetre per day, a meaningful return in the hand can take months rather than weeks; over a distance reaching from the wrist to the shoulder, the process may exceed a year. The first hints of sensation usually appear before strength returns.
Physiotherapy and hand therapy are inseparable parts of this journey. Regular exercises to prevent joint stiffness, keep the muscles ready for their return and help the brain recognise the reconnected nerve directly improve the quality of the outcome. Patience, consistency and regular follow-up are the keys to the best functional gain.
Every nerve, every injury and every patient has a unique recovery story; age, general health, smoking and the type of injury all influence the result. Setting a realistic yet hopeful expectation, making decisions together with you, and managing the process through regular reviews are at the heart of our approach. We encourage you to be evaluated without delay once your symptoms begin.
You may request an appointment for an assessment or a second opinion on this subject.
Request Appointment