Ulna Nerve Release.
Why might I need an ulna nerve release procedure?
Compression and irritation of the ulna nerve at the elbow is called Cubital tunnel syndrome. This results in numbness and tingling in the little and ring fingers and in severe cases causes weakness or wasting of the muscles in the hand.
If your symptoms do not settle with an appropriate trial non-operative measures or if your symptoms are very severe you may require surgery. Mr Moverley will exclude other causes of pain around the elbow such as arthritis or tendon inflammation.
What does surgery involve?
On the day of surgery you will be admitted to the ward or surgical admission area. You will once again meet Mr Moverley who will ensure you are still happy to proceed and that you understand the risks and benefits of the procedure. This is a good opportunity for you to ask any further questions. You will be asked to sign a consent form if you have not already done so.
You will meet your anaesthetist who will explain the type of anaesthetic you will receive. Most ulna nerve release procedures require a general anaesthetic but it can be performed under a nerve block so that the arm will be numb (and you will be awake) for approximately 12 hours post operatively.
A small incision is made over the inside of the elbow and the thickened tissues over the nerve are released in full. Sometimes the nerve may be irritated because it is unstable (flicks in and out of the groove it normally lies in) or compressed by bony prominences around the groove. If this is the case Mr Moverley may move the nerve from its groove into a position where it is under less tension. This is called an ulna nerve transposition.
The wounds are repaired with stitches and covered with a splash proof dressing. The wounds should be kept dry for 10-14 days.
What happens post operatively?
Immediately after surgery your arm will be in a sling, you will have a soft bandage that can be removed after 48 hours. You will be given painkillers if you are in any pain, and these will also be provided upon discharge.
A physiotherapist will assess you to make sure that you can remove and apply the sling safely. They will provide some early exercises to help prevent stiffness of the elbow.
How long is the rehabilitation process?
A sling will be provided to rest the elbow but this should usually only be used for a few days after surgery, this to prevent long-term stiffness. Further physiotherapy appointments are not usually required.
How long will it be before I can…?
Drive 2 weeks
Desk job 2 weeks
Manual work 6 weeks
Golf 6 weeks
Racket sport 6 weeks
Contact sport 6 weeks
What are the potential risks and complications?
As with any operation, a small number of people may have problems after ulna nerve release. Most of these problems are quite minor and can be treated easily. The main risks are:
Infection
Bleeding
Nerve injury
Elbow stiffness
Continued discomfort 10-15%
Is ulna nerve release always successful?
The outcome depends upon the severity of the nerve compression being treated. Numbness and tingling frequently improves, though the improvement may be slow. Surgery generally prevents further worsening of the muscle weakness, but improvements in muscle strength are often slow and incomplete. Recovery of the nerve is highly unpredictable if you have underlying medical conditions such as diabetes mellitus.
In mild cases you can expect there to be full resolution of symptoms in most cases.
The results of ulna nerve release are therefore not guaranteed which is why Mr Moverley will want to consider non-operative measures before proceeding.