Nerve decompression of the forearm is a surgical procedure to cure and release the nerves in the forearm that have become compressed by their surrounding structures.

Physiotherapy after nerve decompression is important to fully regain strength and function in the forearm, wrist and hand after the surgery.

Nerve compression occurs due to a restriction of the space around a nerve. The space can be restricted due to a number of reasons including damaged or inflamed soft tissues (tendons, muscles or ligaments), narrowing of bony space, bone spurs (abnormal bone growth) and loose bodies. The forearm has three main nerves that can become compressed within the forearm.

• Median nerve
• Radial nerve
• Ulnar nerve

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Median nerve

The median nerve originates from the upper spine and travels down the upper arm, elbow, forearm and the through the carpal tunnel in the wrist and into the hand. Most of the muscles on the front of the forearm and some muscles in the hand are supplied by the median nerve.

The median nerve helps flex (bend) and abduct (out to the side) the wrist and fingers as well as pronates the forearm (turns the forearm so that the palm faces downwards). The median nerve supplies the skin of the palm and outer three and half fingers.

The most common place for the median nerve to become compressed is within the carpal tunnel in the wrist, causing carpal tunnel syndrome.

If the median nerve is compressed, the main symptoms experienced are loss of function and weakness in the muscles around the wrist and hand as well as a loss of sensation or tingling in the palm, and outer three fingers.

Radial nerve

The radial nerve originates from the top of the spinal cord and then travels down, winding around the back of the upper arm and then through the elbow joint, down the forearm and then branches off at the back of wrist.

The radial nerve allows the ability to straighten and twist the arm (pronation / supination) as well as helping to extend the wrist, thumb and fingers. The radial nerve provides sensation to the thumb side and the top of the forearm.

Sensation at the back of the middle and index finger as well as the back of the hand is also provided by the radial nerve. The most common place for the radial nerve to become compressed is within the radial tunnel within the forearm.

Ulnar nerve

The ulnar nerve derives from the upper spinal cord and then travels down the upper arm, passing the inner side of the elbow, down the ulnar side of the forearm and down to the wrist and hand (on the little finger side).

The ulnar nerve allows the ability to flex the wrist, fingers and thumb as well as helps adduct (bring in) and oppose the thumb. The ulnar nerve provides sensation in the little finger and some of the ring finger.

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The most common area that the ulnar nerve suffers compression is where it passes through the elbow joint. Symptoms associated with ulnar nerve decompression include weakness and loss of function in the muscles in and around the elbow, wrist, thumb and fingers as well numbness and tingling in the outer side of the hand, the little finger and the ring finger.

It is important to undergo nerve decompression surgery to reduce symptoms associated with an entrapped nerve of the forearm such as pain, tingling, weakness, reduced function as well as prevent permanent damage that can derive from the disorder.

A comprehensive physiotherapy course is necessary to maximize the success of the nerve decompression surgery, prevent any problems occurring in the future and to help ensure the return of full or near to full function in the forearm.

The surgical approach implemented and the type of incision made depends on which of the nerves of the forearm that are entrapped.

A typical nerve decompression procedure is done under general anesthesia and involves the debridement and removal of damaged tissue, adhesions and bone spurs (abnormal bone growth).

By removing the structures that are causing the compression, the affected nerve is subsequently released. The wound made is then closed up using stitches or sutures.

Symptoms after nerve decompression surgery

Immediately after the patient has undergone nerve decompression surgery of the forearm he will feel drowsy and his forearm, wrist and hand will initially feel numb as a result of the anesthetic.

The patient will experience pain and swelling in and around his affected forearm therefore he will be provided with appropriate pain killers. The patient will also be advised to keep his affected upper limb elevated above chest height to maintain good circulation and reduce the swelling.

The patient may be given a splint depending on the type of nerve decompression he had. An arm sling will be provided for essential protection and support and it can be worn when the patient is out and about.

In the initial stages post surgery, the patient will feel some loss of strength, range of movement and function in his forearm and arm therefore physiotherapy will start immediately to aid recovery through appropriate rehabilitation methods.

Physiotherapy after nerve decompression surgery

Physiotherapy is needed as soon as possible once the patient has gone through nerve decompression surgery to manage pain and inflammation as well improving mobility, range of movement and strength in his affected lower arm, wrist and hand.

A comprehensive physiotherapy program will help the patient achieve the return of full or near to full function in his forearm whilst also preventing the likelihood future problems and permanent damage of the nerves.

Rehabilitation offers a program that includes goals that are personal to the patient. Goals of the physiotherapy program will include:

• To restore a symptom free lower arm, wrist and hand
• To restore full muscle strength
• To restore full range of motion (ROM)
• To restore full muscle length and flexibility
• To improve cardiovascular fitness and muscle endurance
• To re-establish function and independence

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