What is ulnar nerve surgery?
Ulnar nerve entrapment of the elbow is an injury to the ulnar nerve that occurs due to nerve decompression at the elbow.
The ulnar nerve runs through the inner arm and forearm into the hand and provides sensation to the ring and little finger and controls various muscles in the hand.
When the nerve is compressed, ulnar nerve entrapment syndrome occurs.
There are two treatment options, on the one hand a non-surgical one based on physical and occupational therapy, accompanied by medication and pharmacological treatment to relieve pain and reduce inflammation. On the other hand, there is the surgical approach, which consists of decompression surgery.
Why is it performed?
Ulnar nerve surgery is used when the ulnar nerve is trapped as it passes through the elbow and when other more conservative treatments such as therapy, medication or rest have failed.
Surgery is performed in order to relieve pain -especially incisive pain in the little finger and ring finger- and the annoying tingling and numbness of the hand. In turn, muscle atrophy occurs in the intrinsic musculature of the hand. This may be accompanied by cramps in the area.
What is ulnar nerve surgery?
In the first instance, the specialist will opt for a non-surgical treatment with the following:
- Non-steroidal anti-inflammatory drugs.
- Immobilization or splinting
- Exercises for nerve gliding
In the event that non-surgical treatment does not achieve results, the specialist may recommend surgery to relieve the pressure on the nerve. This surgery is also indicated in cases where the nerve is very compressed and/or has caused muscle damage, accompanied by weakening.
There are different options to face the surgery:
- Anterior ulnar nerve transposition: there are cases in which the nerve is moved behind the medial epicondyle to a new location to prevent it from being trapped in the bony ridge and stretched when the elbow is bent.
- Medial epicondylectomy: consists of removing part of the medial epicondyle, thus preventing the nerve from catching later when bending the elbow.
This is a treatment that is sometimes performed on an outpatient basis, although treatment is usually best responded to with an overnight stay in the hospital under observation.
Ulnar surgery is performed to decompress the ulnar nerve as it passes through the elbow.
Preparation for ulnar nerve surgery
The specialist will review the patient’s medical history and perform a physical examination. No special preparation is required. Some tests to confirm the condition of the nerves are:
- X-ray imaging tests
- Nerve conductivity studies
Care after the procedure
The procedure can be done on an outpatient basis, i.e. without hospital admission or with an overnight hospital stay. During the hospital stay, the patient may be given analgesics to relieve pain.
A bandage will be applied to cover the incision area and then the patient will be discharged. The patient will gradually begin to perform daily activities, recovering his or her usual activity around six months after undergoing surgery.
Alternatives to ulnar nerve surgery
Alternatives to surgery focus mainly on non-surgical treatment of the elbow injury. Thus, the specialist may initially choose to suggest to the patient the initiation of physical and occupational therapies that can help strengthen the ligaments and tendons of both the elbow and the hand.
Depending on the severity of the entrapment, the specialist may prescribe analgesics and non-steroidal anti-inflammatory drugs to reduce both inflammation and pain.
If surgery is necessary, the alternative approach is minimally invasive surgery, which reduces the size of the incision while reducing the approximate recovery time from the injury.