Compression neuropathies are among the most common — and most under-diagnosed — conditions affecting the upper and lower extremities. Compression neuropathy means that a nerve is compressed at one point or multiple points along its course, producing pain, numbness, weakness, and progressive loss of function in the muscles and skin that nerve serves. Many patients live with compression neuropathies for years, attributing their symptoms to age, repetitive use, or other causes, before reaching an accurate diagnosis. The challenge with these conditions is twofold: first, they often co-exist (carpal tunnel and cubital tunnel together, for example), which can confuse the diagnosis; second, the longer a nerve remains compressed, the lower the chance of complete recovery — meaning early surgical decompression often produces dramatically better outcomes than delayed treatment. At Los Angeles Plastic Surgery in Beverly Hills, Dr. John Anastasatos diagnoses and surgically treats the full spectrum of peripheral nerve compression syndromes of the upper and lower extremities.

Dr. Anastasatos performs peripheral nerve surgery with the most directly relevant academic credential possible: he completed a fellowship in Hand and Upper Extremity Surgery and Microsurgery at the University of Alabama at Birmingham — formal subspecialty training in peripheral nerve surgery that few cosmetic plastic surgeons possess. He has presented academic work at UAB Grand Rounds on “The Microsurgical Repair of Peripheral Nerves” — directly relevant to the surgical decompression and microsurgical reconstruction techniques used to treat compression syndromes. With over two decades of facial and hand surgical expertise in Beverly Hills since 2007, he is board certified by the American Board of Plastic Surgery, a Fellow of the American College of Surgeons (FACS), a member of the American Society of Plastic Surgeons (ASPS) and American Society for Aesthetic Plastic Surgery (ASAPS), and named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World.

Why Early Treatment Matters

Compression neuropathies should be addressed earlier rather than later. The reason is biological: nerves are responsible for proper function of the muscles they innervate and for sensation in the skin they supply. The longer a nerve is compressed, the higher the chance of incomplete recovery even after surgical correction. Patients who tolerate symptoms for years before seeking treatment may achieve only partial recovery — even with technically perfect surgery. The sooner the compression is relieved, the more complete the return of muscle and sensory function.

Upper Extremity Compression Neuropathies

Median Nerve Compression Syndromes

Carpal Tunnel Syndrome

Carpal tunnel syndrome is the most common compression neuropathy — affecting up to 10% of the general population in varying degrees. The median nerve becomes compressed within the carpal tunnel at the wrist, where bony walls (the wrist and palm bones) and a thick fibrous transverse carpal ligament create the anatomical canal. Compression typically results from a thickened, inflamed transverse carpal ligament that constricts the nerve.

Symptoms commonly include:

• Pain and numbness of the wrist, palm, thumb, index finger, and long (middle) finger
• Symptom worsening with wrist flexion
• Night-time awakening due to pain, numbness, and tingling — a particularly characteristic complaint, caused by wrist flexion during sleep
• Variable presentations: some patients have wrist pain only, some have palm tingling only, some have finger tingling only

Professionals who use their hands repetitively are particularly susceptible — including musicians and typists.

Diagnosis is made on physical examination and confirmed with nerve conduction velocity studies. A thorough evaluation by a hand surgeon is essential because carpal tunnel often co-exists with other compression neuropathies — including ulnar nerve compression at the elbow and brachial plexus neuropathy — and the co-existence can confuse the diagnostic picture.

Therapy:

• The effective treatment is surgical decompression — open or endoscopic. Either technique is equally effective. Dr. Anastasatos performs both and selects the optimal approach for each patient after thorough evaluation.
• Many advertised non-surgical therapies — steroid injections, lasers, daytime splints, Vitamin B6, magnets, and topical creams — do not work in the long run and are not proper long-term effective treatments.
• Wrist splints can ameliorate symptom severity but do not treat the underlying condition.
• The procedure is quick (15-30 minutes), patients go home the same day, and most return to regular activities within a week.
• Dr. Anastasatos can perform carpal tunnel release under local anesthesia only — for patients afraid of general anesthesia.
• Recurrence is possible; the proper therapy in that case is again surgical decompression.

Anterior Interosseous Nerve Syndrome

Compression of the median nerve occurs at a higher location near the elbow due to fascial bands or certain forearm muscles. This produces primarily a motor deficit — weakness of the flexor digitorum profundus of the index and long fingers and weakness of the pronator quadratus. The typical presentation is inability to flex the terminal phalanges of the thumb, index, and long fingers.

Therapy: Surgical decompression — the hand surgeon identifies the area of compression and divides the compressive bands, freeing the median nerve and improving the weakness.

Pronator Syndrome

Entrapment of the median nerve in the forearm produces an 8-24 month history of forearm weakness, aching, and pain. The pain is non-localized. On examination, resisted forearm pronation reproduces the pain.

Therapy: Surgical decompression of the constrictions.

Radial Nerve Syndromes

Superficial Radial Nerve Entrapment

Compression along the radial nerve in the lower forearm, wrist, and hand — typically caused by compressive bands, tight gloves, or a tight cast. There is no motor deficit, and once the compression is relieved, function returns to normal. Note: de Quervain’s tenosynovitis is often mistaken for radial sensory nerve compression — proper history, physical examination, and evaluation by a hand surgeon clarify the diagnosis.

Posterior Interosseous Nerve Syndrome

Presents as inability to extend one or more digits. In severe cases, the patient cannot extend the thumb, index, long, ring, or little fingers. There is no sensory deficit.

Therapy: Surgical decompression. Note: this syndrome is often confused with lateral epicondylitis or resistant tennis elbow — and radial tunnel syndrome and tennis elbow can co-exist. Thorough evaluation is critical.

Ulnar Nerve Compression Syndromes

Guyon’s Tunnel Syndrome

The distal ulnar nerve is compressed as it enters the wrist by the hook of the hamate bone, the pisiform bone, or the Guyon canal itself. Pure motor, pure sensory, or combined deficits can occur.

Therapy: Surgical decompression.

Cubital Tunnel Syndrome

The ulnar nerve is compressed at the elbow, producing combined motor and sensory deficits. This is the second most common compression neuropathy after carpal tunnel syndrome.

Therapy: Surgical decompression at the elbow. Transposition of the ulnar nerve may be required.

Musculocutaneous Nerve Entrapment

Dysfunction can produce weakness or paralysis of the biceps and brachialis muscles. Sensory deficit along the lateral forearm may also be present.

Therapy: Surgical exploration and decompression along the course of the nerve.

Bowler’s Thumb

First described in bowlers and baseball batters. Pain and numbness of the thumb, sometimes with a palpable mass at the base of the thumb. The condition is an overuse syndrome caused by repetitive external compression.

Therapy: First-line therapy is conservative — rest, anti-inflammatory agents, steroid injections, and splinting. If conservative measures fail, surgical exploration and decompression are indicated.

Thoracic Outlet Syndrome

Compression of the nerves as they exit the cervical spine — by the scalene muscles, the first rib, or other structures. Produces brachial plexus neuropathy with diverse symptoms reflecting compression of the median, radial, musculocutaneous, and ulnar nerve distributions.

Therapy: Surgical exploration, resection of neuromas in continuity, nerve grafting, nerve transfer, and surgical decompression — essentially a brachial plexus reconstruction.

Lower Extremity Compression Neuropathies

Common Peroneal Nerve

The common peroneal nerve is relatively fixed at the lateral fibula, near the lateral aspect of the knee and upper leg. Its location close to the skin and over the bone makes it vulnerable to injury and compression — a frequent injury Dr. Anastasatos sees in athletes.

Injury at the fibular head produces a feeling of the leg “giving out” — because the peroneal nerve controls ankle extension and eversion (outward motion). Weakness in these movements creates the sensation of foot loss of control. Ankle sprain is a common cause: the sprain produces traction on the nerve that injures it.

Therapy: Conservative initially. If no progress within a reasonable window, surgical exploration and nerve repair are indicated.

Morton’s Neuroma

A condition first described by Morton in 1875 — compression of the common plantar digital nerve.

Therapy: Treatment ranges from excision of the diseased nerve segment to division of the intermetatarsal ligament that causes the chronic compression.

Lateral Femoral Cutaneous Nerve Compression (Meralgia Paresthetica)

An often-unrecognized condition caused by injury to the lateral femoral cutaneous nerve. Causes include prior hernia repair, prior hysterectomy, lower abdominal surgeries, diabetes, and wearing abdominal girdles or corsets.

Therapy: Surgical exploration, release of the compressed nerve, and nerve repair.

Schedule a Nerve Compression Consultation in Beverly Hills

If you have unexplained numbness, tingling, weakness, or pain in the hands, arms, or legs, an evaluation for compression neuropathy may be warranted. Dr. Anastasatos welcomes patients to the Beverly Hills office at 436 North Bedford Drive, Suite 202, Beverly Hills, CA 90210, for a private consultation. Contact Los Angeles Plastic Surgery to schedule a consultation with Dr. Anastasatos.