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Peripheral nerve surgery · London

Decompression and neurolysis of nerves - releasing a trapped nerve, properly.

Carpal, cubital, tarsal tunnel and beyond - a consultant who does peripheral nerve work week in, week out, with NCS-guided planning and imaging when the picture is not obvious.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private nerve decompression costs in London.

Indicative ranges across UK private providers.

In short

£1,800–£3,200, home the same day.

Procedure Indicative range
Carpal tunnel release (open, LA) £1,800–£3,200
Carpal tunnel release (endoscopic) £2,400–£4,200
Cubital tunnel decompression £2,800–£5,500
Tarsal tunnel release £3,200–£5,800
Common peroneal decompression £3,000–£5,500
Meralgia paraesthetica release £2,800–£5,200
Revision release with nerve wrap £4,500–£8,500
Consultation and NCS package £450–£850

Prices vary by clinic, by which surgeon does the case, by the anaesthetic chosen, and by whether extra work (nerve wrap, ganglion removal, transposition) is added on the day.

The problem

The right nerve, the right site, the right operation.

Nerve compression is a diagnosis that rewards precision. Wrong nerve, wrong level or a missed second site of compression is why so many operations disappoint.

  • Not sure it is a nerve?

    NCS and EMG confirm which nerve, where, and how bad - before anyone reaches for a scalpel.

  • Not sure surgery is needed?

    A splint, an ergonomic change or a single steroid injection can be enough. We say so before you agree to surgery.

  • A previous release that did not work?

    Revision nerve surgery is its own discipline - imaging with MRN, and a surgeon who does revisions, not their first one.

Which nerve, and where

The nerves we most commonly decompress.

Every peripheral nerve has favourite pinch points. The right diagnosis names both nerve and site - and rules out a second one.

  • Carpal tunnel (median at wrist)

    Numbness and tingling in the thumb, index, middle and half the ring finger - often waking you at night. Thenar wasting in advanced cases.

  • Cubital tunnel (ulnar at elbow)

    Pins and needles in the little and ring fingers, weak grip, elbow pain. Interosseous wasting in the hand if left too long.

  • Guyon’s canal (ulnar at wrist)

    Ulnar-sided numbness or weakness from a ganglion, repetitive pressure, or a hook of hamate injury.

  • Radial tunnel and posterior interosseous

    Deep, aching lateral forearm pain - sometimes mistaken for tennis elbow - with or without weakness of finger extension.

  • Common peroneal at the fibular neck

    Foot drop, tripping, numbness across the top of the foot - often after weight loss, prolonged squatting or a leg cast.

  • Tarsal tunnel (posterior tibial at ankle)

    Burning, tingling or shooting pain in the sole of the foot, worse on standing and at night.

  • Meralgia paraesthetica (lateral thigh)

    Numb, burning patch over the outer thigh from lateral cutaneous nerve compression at the groin. Often settles with weight, belts and posture - surgery for the ones that do not.

  • Red flag: progressive motor loss or wasting

    Visible muscle wasting, foot drop, or a hand you can no longer grip with is not a wait-and-see situation. Sooner is better than later.

Procedure options

The techniques on the table.

Open or endoscopic, external or internal neurolysis, with or without a nerve wrap - the right choice depends on the nerve, the severity, and whether this is a first or a revision operation.

  • Open carpal tunnel release

    Small palm incision to divide the transverse carpal ligament. Reliable, quick, done under LA - still the workhorse operation.

  • Endoscopic carpal tunnel release

    Camera through one or two tiny incisions. Faster return to heavy grip work, similar long-term outcomes to open release.

  • Cubital tunnel decompression

    In-situ decompression of the ulnar nerve at the elbow. Anterior transposition (subcutaneous or submuscular) reserved for unstable or revision cases.

  • Guyon’s canal release

    Wrist-level release of the ulnar nerve, usually with removal of a ganglion or lipoma if that is the cause.

  • Tarsal tunnel release

    Release of the flexor retinaculum at the ankle to decompress the posterior tibial nerve and its branches.

  • Common peroneal decompression

    Release of the nerve at the fibular neck. Best done before dense foot drop and wasting set in.

  • External vs internal neurolysis

    External: freeing scar from around the nerve. Internal: opening the epineurium to release intraneural scarring - reserved for chronic or revision cases.

  • Nerve wrap for revision surgery

    A collagen or vein wrap around a scarred nerve after re-do decompression to reduce re-scarring.

Safety, complications and recovery

What to expect afterwards - honestly.

Nerve decompression is generally a very safe day-case operation. The things worth planning are your anaesthetic, your rehab, and knowing what is normal - and what is not.

  • Local, regional or GA

    Most wrist-level releases are done under LA. Elbow, ankle, thigh and revision work usually needs regional block or GA - with an anaesthetist, in a proper theatre.

  • Sensory recovery is quick, motor is slow

    Tingling and night pain often improve within days. Strength, dexterity and any muscle wasting recover over months - sometimes not fully if you waited too long.

  • Scar tenderness for a few months

    Palm, elbow and ankle scars can be tender for two to three months (pillar pain in carpal tunnel). Massage and desensitisation help.

  • Incomplete relief is possible

    A minority of patients - particularly with severe pre-op NCS changes or diabetes - get partial rather than complete relief.

  • Recurrence and revision

    True recurrence is uncommon but real. Persistent symptoms are worked up with repeat NCS and MRN before considering revision surgery.

  • Nerve injury is rare - and taken seriously

    Iatrogenic injury to the nerve being decompressed, or a nearby branch, is uncommon in specialist hands but a real risk we consent for.

  • Complex regional pain syndrome (CRPS)

    A rare but recognised complication with disproportionate pain, swelling and colour change - early recognition and pain-team input matter.

  • Rehab is not optional

    Early gentle movement, nerve gliding and - where relevant - a hand therapist make the difference between a good and an excellent result.

  • Red flags

    Progressive weakness, spreading numbness, disproportionate burning pain, fever or wound breakdown after surgery - call the team or A&E the same day.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever nerve and technique, the note the surgeon sends you keeps to the same shape.

A UK consultant reviewing a patient’s nerve decompression operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your review, just ask.

  1. 01 Header

    Indication and nerve treated

    Which nerve, at which site, and what the pre-op NCS/EMG and imaging showed - the objective reason for surgery.

  2. 02 Technique

    Anaesthetic and surgical technique

    LA, regional or GA. Open or endoscopic. External or internal neurolysis. Any transposition, ganglion removal or nerve wrap used.

  3. 03 Findings

    Intra-operative findings

    What the surgeon actually saw - the degree of compression, any ganglion, lipoma, scar or anatomical variant, and the appearance of the nerve.

  4. 04 Impression

    Recovery, rehab and expected timeline

    Read this first: dressings, splint or not, when to move, hand therapy or physio, and realistic timelines for sensation, strength and any wasting.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Nerve decompression is generally covered by major UK insurers where medically indicated.

Frequently asked

Everything we get asked about nerve decompression.

Quick answers on diagnosis, alternatives to surgery, recovery timelines and what to do if the first operation did not work.

  • How do I know which nerve is the problem?

    Clinical examination - including Tinel’s tap and Phalen’s test for carpal tunnel - narrows it down. Nerve conduction studies (NCS) and EMG confirm which nerve is compressed, where and how badly. High-resolution nerve ultrasound and MR neurography (MRN) help in atypical, revision or suspected mass cases.

  • Do I need surgery, or will splinting or injection be enough?

    Mild or intermittent carpal tunnel often improves with a night splint or a steroid injection. Cubital tunnel can settle with elbow-extension splinting. Progressive symptoms, muscle wasting or severe NCS changes need surgery - waiting risks incomplete recovery.

  • Open or endoscopic carpal tunnel release?

    Long-term outcomes are similar. Endoscopic release usually means less palm tenderness and a slightly quicker return to heavy grip. Open release is quick, reliable and cheap. Your surgeon will recommend based on your anatomy and their experience.

  • How long is recovery after nerve decompression?

    Numbness and night pain often ease within days. Full return to heavy manual work takes four to six weeks after carpal tunnel, longer for cubital, tarsal or peroneal releases. Strength and any muscle wasting recover over three to twelve months.

  • What if the surgery does not fully work?

    Partial relief is possible, particularly with severe pre-op NCS changes, diabetes or long-standing symptoms. Persistent or recurrent symptoms are worked up with repeat NCS and MRN before considering revision - often with a nerve wrap.

  • When should I see a doctor urgently?

    Visible muscle wasting (for example thenar wasting in advanced carpal tunnel), foot drop, rapidly progressive weakness, or disproportionate burning pain and swelling after surgery (possible CRPS) all need urgent review - not a routine appointment.

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