Procedure description

The ulnar nerve is a nerve which supplies sensation and strength to a portion of the hand and forearm.  It may become compressed or trapped as it courses past the olbow.  Ulnar nerve decompression at the elbow is performed when the ulnar nerve is entrapped at the elbow.  The pressure on the ulnar nerve may cause pain or numbness and tingling in the little finger and half of the ring finger.  There may be weakness as well.  Several surgical procedures are available to relieve the entrapment of the nerve at the elbow.  The nerve may be simply decompressed.  Alternatively, the nerve may be decompressed and transposed (moved) to a new location.  A medial epicondylectomy (removal of a bony prominence in the elbow, which may be bruising the nerve) may be performed. 

Procedure Risks

Ulnar nerve decompression has a lower success rate than carpal tunnel release.   Risks of the procedure can be broken down into two categories, 1) those related to the operative site, and 2) those related to the risks of anesthesia. 

Risks related to the operative site: 

Surgical Exposure:  The patient is placed in a supine position (on their back).      In this position, there can be pressure sores to the skin and  pressure injuries to nerves.   During surgical dissection, injury to muscle, nerves, blood vessels, and the elbow joint  in the area can occur.

Nerve injuries: If there is any injury to the nerves in the forearm or elbow,  the consequences may involve loss of sensation, increased burning sensation, paralysis and weakness.  

General Risks:  These include  general difficulties, such as bleeding, infection, stroke, paralysis, coma and death.  There is also the possibility that the surgery may not relieve the symptoms for which the procedure was performed.  The problem for which the surgery was performed may recur, requiring additional surgery in the future.  In addition, although every attempt is made to protect all areas of the body from pressure on nerves, skin and bones, injuries to these areas can occur, particularly with prolonged cases.

Risks of Anesthesia:
A general  anesthetic is often used.  Although unlikely, blood clots in the legs could develop, heart attack and reaction to the anesthetic may occur, and reaction to blood transfusion ( if  given) may result. 

 

Post-operative care:

There shall be no heavy lifting until cleared by the surgeon.  Be patient with the nerve healing.  Numbness may persist for a long time or indefinitely, or it may improve.
 
The following is a list of suggestions that should help speed your recovery and give you every possible chance for the best results from your surgery.

1. Immediately upon discharge, contact our office and set up an appointment for staple removal if one has not already been made.
   
2. Take it easy until seen by the physician.  This does not mean bed rest, but athletic activities during this period are definitely not recommended.  Please give your incision a chance to heal.  Avoid bending.
   
3. Wear your sling as prescribed  by your surgeon.
   
4. Lift nothing heavier than a half gallon of milk until seen by your doctor.
   
5. Every hour, while awake, wiggle the fingers, and gently squeeze a foam cushion or sponge.
   
6. After you get home, you may begin walking up to one mile per day.
   
7. You may walk up or down steps as often as you like.  Please take them smoothly and slowly.
   
8. No driving until OK with your physician.    This applies during the first month after surgery.
   
9. You may shower after you go home unless otherwise instructed.  Cover the incision with plastic wrap before the shower and remove it afterward.  Change dressing immediately.  Tub baths are not advisable.  You may shower without covering the incision one week after the sutures are out.  Follow instructions concerning care of tape strips, stitches or staples.  Your surgeon or  nurse clinician will explain the techniques used in the closure of your incision.
   
10. Sexual activities are permitted.
    
11. If you notice swelling, redness or opening of the incision, or if there is any clear fluid draining from it, please contact your surgeon immediately!  If you develop a fever, stiff neck or chills, contact the office immediately.  Take your temperature at 4:00 PM daily until the clips are removed.  Call if greater than 101 degrees Fahrenheit.
    
12. If you have any questions, call our office, and for after hours emergencies, call the after hours number.
    
13. Take your medications prescribed on discharge, as directed.
    
14. It takes 6 - 18 months for a nerve to heal.  During that time you may experience numbness, tingling, fleeting pain, or creepy/crawly sensations.