Abstract
Compression neuropathies comprise a diverse spectrum of peripheral nerve disorders resulting from chronic mechanical insult within anatomically constrained fibro-osseous or myofascial tunnels. Although common entities such as carpal and cubital tunnel syndromes are well established, several less frequently addressed compression syndromes remain diagnostically and therapeutically controversial. This chapter reviews contemporary advances in the pathophysiology, diagnostic evaluation, and surgical management of select complex compression neuropathies, with specific focus on thoracic outlet syndrome (TOS), groin and pelvic neuropathies, and common peroneal nerve entrapment. TOS continues to generate debate regarding diagnostic criteria and operative indications; however, in carefully selected patients, supraclavicular decompression with first rib and scalene resection yields high rates of durable symptom relief. Neuropathic groin and pelvic pain syndromes-including ilioinguinal, genitofemoral, and pudendal neuropathies-require rigorous clinical assessment, exclusion of proximal pathology, and confirmatory diagnostic nerve blocks prior to intervention. Contemporary reconstructive strategies, including targeted muscle reinnervation and regenerative peripheral nerve interfaces, have expanded surgical options for refractory neuromas. Common peroneal nerve compression, including subclinical presentations preceding overt foot drop, underscores the importance of early recognition and timely decompression to mitigate irreversible axonal degeneration. Detailed patient selection, early and anatomically comprehensive decompression, and adherence to principles of peripheral nerve biology are essential to optimize functional outcomes in modern peripheral nerve surgery.