The ulnar nerve runs from the neck through the elbow, and can become compressed or irritated. Most commonly, compression can occur behind the inside part of the elbow, but can also become compressed beneath the collarbone or at the wrist. When it is compressed at the elbow, the disorder is known as cubital tunnel syndrome. Common symptoms include numbness and tingling in the hand and fingers. Most symptoms can be managed with nonsurgical treatment. However, in some cases, surgical treatment may be necessary if symptoms persist even after significant nonsurgical treatment.
There are two main surgical treatments for ulnar nerve release. Both are generally outpatient procedures that do not require general anesthesia. Typically, local anaesthesia combined with intravenous sedation is used.
- Cubital tunnel release: An incision is made over the ulnar nerve at the elbow. The ligament that forms the roof of the cubital tunnel (through which the ulnar nerve passes) is cut and divided, which decreases pressure on the nerve by increasing the tunnel size. The external wound is then closed with sutures.
- Ulnar nerve anterior transposition: The surgeon will make an incision over the ulnar nerve in the elbow. The nerve will then be moved from behind the medial epicondyle (the bone on the inside of the elbow) to in front of it. The nerve’s new location may be either beneath the muscle, within the muscle, or on top of it, just under the skin and fat. The external wound is then closed with sutures.
Who is a candidate?
Candidates for ulnar nerve release typically have exhausted nonsurgical treatment options or have a highly compressed ulnar nerve that has been recommended for surgery.
Who is not a candidate?
Patients who have not yet exhausted nonsurgical treatment options for cubital tunnel syndrome are not candidates for ulnar nerve release.
Like other surgeries, trigger finger release requires a complete physical examination with your primary care provider and/or orthopedic surgeon prior to surgery. You should inform your orthopedic surgeon of any medications or supplements you take, and comply with general surgery procedures such as preoperative blood testing and possible cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior to surgery. You may need to stop taking blood thinner medication if you are on a regular dose of drugs such as Warfarin (or other blood thinners).
As an outpatient procedure, ulnar nerve release typically requires no overnight hospital stay. Keeping your arm elevated will reduce swelling for the first 2 days post-surgery. You will most likely need to wear a splint for the first few weeks after the operation. For an ulnar nerve anterior transposition, you may require longer, including up to 6 weeks. Your physician may give you at-home exercises to help regain strength and motion in your arm.
As with any surgery, there are risks of complications related to bleeding and infection. However, ulnar nerve surgery is relatively low risk in terms of anesthesia-related complications, as only local anaesthesia is used. There is also a small risk that ulnar nerve release may not relieve symptoms of cubital tunnel syndrome.
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