The ulnar nerve is one of the major nerves in the arm, responsible for providing feeling to the ring and little fingers as well as controlling several muscles in the hand. It runs from the neck, through the axilla (armpit), through the medial elbow, and into the hand. When this nerve becomes compressed or irritated, it can lead to ulnar nerve entrapment, commonly referred to as cubital tunnel syndrome when it affects the elbow.
If non-surgical treatments, such as rest, physical therapy, or splinting, fail to relieve symptoms of ulnar nerve compression, ulnar nerve decompression surgery may be considered. This guide provides a detailed overview of the condition, the surgery, the benefits and risks, recovery expectations, and what you can expect before, during, and after the procedure.
At Endoscopic & Minimally Invasive Spine Specialists, we have extensive experience and expertise with ulnar nerve decompression surgery and provide the highest-quality care in surgical and non-surgical neurosurgical care.
To learn more about ulnar nerve decompression surgery, call the office today or request an appointment online.
This guide will help you understand the condition, the procedure, its benefits, risks, and the recovery process.
What is Ulnar Nerve Entrapment?
The ulnar nerve travels from the neck, down the arm, through the elbow at a specific location known as the cubital tunnel, and into the hand. At the elbow, the ulnar nerve is especially vulnerable because it passes through a narrow passageway formed by bone, ligament, and muscle. This area is located on the inside of the elbow and is often referred to as the “funny bone” because of the sharp sensation when the nerve is accidentally bumped.
Ulnar nerve entrapment occurs when the ulnar nerve becomes compressed or irritated at the elbow, causing symptoms that include:
- Numbness and tingling in the ring and little fingers, especially when bending the elbow or at night.
- Weakness in the hand, particularly in grip strength or finger coordination.
- Pain on the inside of the elbow or forearm, which may radiate down into the hand.
- Muscle wasting in the hand, particularly in the area of the hypothenar eminence (the base of the little finger).
These symptoms may initially come and go but can worsen over time if untreated, leading to permanent nerve damage or loss of hand function. Ulnar nerve entrapment is often caused by prolonged pressure on the nerve (such as resting the elbow on a hard surface), repetitive motion, or anatomical issues like an abnormal structure of the cubital tunnel.
When is Ulnar Nerve Decompression Surgery Needed?
In many cases, ulnar nerve entrapment can be managed with conservative treatments such as:
- Resting the elbow and avoiding positions that place pressure on the nerve.
- Physical therapy to improve range of motion and strengthen the muscles around the elbow and forearm.
- Splinting or using elbow braces to prevent excessive bending or stretching of the arm.
- Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.
However, if these treatments do not provide relief or if the nerve compression leads to significant muscle weakness or permanent nerve damage, your doctor may recommend ulnar nerve decompression surgery. This surgery is typically recommended when:
- There is persistent pain, numbness, or tingling that interferes with daily activities.
- Muscle weakness or atrophy develops in the hand or fingers.
- There is no improvement with non-surgical treatments.
- The compression has caused nerve damage that could lead to permanent disability if left untreated.
What is Ulnar Nerve Decompression Surgery?
Ulnar nerve decompression surgery is a procedure designed to relieve pressure on the ulnar nerve at the elbow. The goal is to release the nerve from any constrictions or compression points, thereby improving its function and alleviating symptoms. The surgery can be done through different approaches depending on the severity of the nerve compression and your individual case.
There are several surgical options for decompression of the ulnar nerve, including:
1. In Situ Decompression: In this procedure, the surgeon makes a small incision over the elbow and carefully releases any surrounding structures that are compressing the ulnar nerve, such as fibrous bands or thickened tissue, while leaving the nerve in its original position. This is the least invasive option and is suitable for mild to moderate cases of compression.
2. Ulnar Nerve Transposition: In more severe cases, the ulnar nerve may be moved (transposed) from the cubital tunnel to a new position, usually in front of the elbow or along the upper arm. This is done to reduce the likelihood of future compression, especially in patients with a narrow or tight cubital tunnel.
3. Medial Epicondylectomy: In this procedure, a small portion of the bone at the inside of the elbow (the medial epicondyle) is removed to create more space for the ulnar nerve. This is typically done in combination with other decompression techniques for the most severe cases.
How Ulnar Nerve Decompression Surgery Works
The surgery is generally performed under local anesthesia with sedation, although general anesthesia may be used in some cases. Here is an overview of the procedure:
1. Preparation and Anesthesia: The surgical site will be cleaned and marked, and anesthesia will be administered. You will be positioned with your arm resting comfortably, usually in a relaxed position.
2. Incision: The surgeon will make an incision over the inner part of the elbow, where the ulnar nerve is compressed. The length of the incision depends on the type of surgery being performed (in situ decompression, transposition, or medial epicondylectomy).
3. Nerve Decompression: In in situ decompression, the surgeon will carefully remove any scar tissue, thickened ligaments, or other structures pressing on the ulnar nerve. In nerve transposition, the surgeon will relocate the nerve to a new position. If a medial epicondylectomy is performed, a small piece of bone will be removed to make more space for the nerve.
4. Closure: After the compression is relieved, the surgeon will close the incision with sutures and surgical adhesive, and the area will be bandaged and your arm placed in a sling to reduce your use of the arm for a week. A sterile dressing will be applied to protect the site.
5. Recovery: The procedure typically takes about 30 minutes, and patients are able to go home the same day. However, you will need to arrange for someone to drive you home.
Benefits of Ulnar Nerve Decompression Surgery
Ulnar nerve decompression surgery can provide significant relief for individuals suffering from ulnar nerve entrapment. Some of the key benefits include:
- Improved Nerve Function: By relieving the pressure on the ulnar nerve, the surgery can restore sensation and reduce tingling, numbness, and pain in the affected fingers and hand.
- Reduced Pain: The surgery aims to eliminate or significantly reduce the pain caused by nerve compression, which can help improve your quality of life.
- Increased Strength: For patients experiencing hand weakness or atrophy, surgery can help restore strength and function, improving the ability to grasp and manipulate objects.
- Prevention of Permanent Nerve Damage: Untreated ulnar nerve entrapment can lead to irreversible nerve damage. Surgery helps prevent this and protects the long-term health of the nerve.
Risks and Complications
Although ulnar nerve decompression surgery is generally safe, it does carry some risks, as with any surgical procedure. Possible complications include:
- Infection: There is a risk of infection at the surgical site, which can be minimized by following your doctor’s post-operative care instructions.
- Nerve Injury: In rare cases, the ulnar nerve or other nearby nerves may be damaged during surgery, potentially causing more pain or further weakness.
- Scarring: While scarring is usually minimal, it may occur, and in some cases, it may cause stiffness or discomfort.
- Persistent Symptoms: In some cases, symptoms may not be fully relieved after surgery, or they may return over time. This is more likely if the nerve has been compressed for a long period before surgery.
- Stiffness or Loss of Range of Motion: Some patients may experience stiffness or loss of flexibility in the elbow joint after surgery.
Recovery After Ulnar Nerve Decompression Surgery
Recovery after ulnar nerve decompression surgery typically follows a predictable course, but it can vary from patient to patient. Here is what to expect:
1. Immediate Post-Operative Care: After surgery, you will be given pain medication to manage any discomfort. The surgical site will be wrapped in a sterile dressing, and you may be asked to keep the arm elevated to reduce swelling.
2. Splinting: You may be asked to wear a splint or bandage to keep the elbow in a neutral position during the initial healing phase, typically for 1-2 weeks.
3. Physical Therapy: In some cases, physical therapy is recommended to restore movement and strength in the elbow and hand. Therapy can help you regain range of motion, prevent stiffness, and strengthen the muscles around the elbow and hand.
4. Follow-up Appointments: You will have follow-up appointments with your surgeon to monitor your recovery, check for signs of infection, and remove any stitches if necessary.
5. Return to Activities: Full recovery can take 3-6 months, although most patients are able to return to light activities within 2-3 weeks. It is important to avoid heavy lifting, repetitive motions, or strenuous activities during the early stages of recovery.
Long-Term Outlook
The long-term outlook for ulnar nerve decompression surgery is generally excellent. Most patients experience significant improvement in their symptoms, including pain relief, restored sensation, and increased hand strength. However, it is important to follow your doctor’s instructions for rehabilitation and lifestyle modifications to prevent future nerve compression.
Contact EMISS to Schedule Your Procedure
Ulnar nerve decompression surgery is a highly effective treatment for ulnar nerve entrapment, particularly for patients who have not found relief with conservative treatments. By alleviating pressure on the nerve, the surgery can restore function, reduce pain, and improve your quality of life. If you are considering surgery, be sure to discuss your symptoms, treatment options, and expectations with your healthcare provider to determine if ulnar nerve decompression is the right choice for you.
To learn how you can benefit from ulnar nerve decompression surgery and patient-centered care your neurosurgical and spinal problems, call Endoscopic & Minimally Invasive Spine Specialists today, or book an appointment online.
