Surgery for unmeasurable neuropathy to alleviate non-specific upper extremity pain: round table discussion

Nerve surgery for unmeasurable upper extremity neuropathophysiology – such as pronator syndrome, supinator syndrome/radial tunnel syndrome, lacertus syndrome, and neurogenic thoracic outlet syndrome – remains a subject of ongoing debate due to the lack of objective reference tests confirming the diagnoses. This round table discussion outlines the perspectives of five expert surgeons navigating the clinical and ethical uncertainties of offering surgery for theoretical neuropathies presenting as non-specific pain. The panel explores the balance between subjective patient reporting and objective diagnostic limitations, the ethical implications of surgical placebo effects, and how to determine treatment effectiveness. The discussion highlights the divergent strategies among specialists regarding risk tolerance, overtreatment, and the implementation of shared decision-making in the absence of measurable disease.