Ulnar nerve compression at the elbow - Treatment with decompression/transposition

The ulnar nerve is frequently compressed at the elbow. It is often called the "trouble-maker" nerve and can be compressed by 7 different structures as it travels past the elbow!

Ulnar nerve compression can be caused by elbow arthritis, previous trauma or injury around the elbow, or abnormal lumps and bumps around the elbow. It can also happen without any obvious causes (idiopathic). 

Symptoms of ulnar nerve compression including discomfort, numbness, or tingling in the hand, fingers, and forearm. The most typically involved fingers are the little finger and ring finger. Sometimes however, the whole hand can feel like it's affected. The symptoms can be particularly worse at night time or when the elbow is bent up, such as when using the mobile phone for a long time. Weakness can also occur, and this may present as tendency to drop objects, "clumsiness", and hollowing of the usual contours of the hand (caused by reduced bulk of hand muscles). 

The following is a schematic diagram of the ulnar nerve as it travels past the elbow:

Surgical Treatment:

Broadly speaking, there are two major types of surgeries that can be done to relieve symptoms of your ulnar nerve compression: 

  1. Decompression of the nerve "in-situ" and leaving it in its original position

  2. Decompression of the nerve and transposing (moving) it to a new position more anterior in the elbow

Kemble will choose the best option for your elbow, based on degree of symptoms, previous surgery, and whether there is abnormality of the original "home" of the nerve. In general, option 1 can be done through a smaller incision, with quicker recovery, and option 2 requires a larger incision. 

Post-operative Management

  • It is normal to have some tingling, numbness or weakness following your procedure. This is often due to a nerve block performed preoperatively to help with your pain, or with postoperatively injected local anaesthesia. This will wear off in the first day or two.

  • It is very important post-operatively that you work with your therapist immediately in trying to regain motion. You will need to start moving your elbow straight-away to get the best result

  • Please keep your dressing/bandage dry. You may use a plastic bag tied above the elbow to prevent the dressing/wound from getting wet during shower/bathing

  • You may remove the outer bandage after 3 days. there will still be dressing on underneath.

  • Around 2 weeks following surgery, you should have your wound checked. 

Recovery

  • After the wound has been checked, and if this has all healed well, then you may leave the wound open and get it wet in showers/swimming pools etc

  • For the first 2 weeks following surgery, please limit weight-bearing to a "cup-of-tea" weight. Thereafter, you can resume all activities if cleared by Kemble

  • The symptoms of ulnar nerve compression that you had initially prior to surgery may not go away immediately. In fact, it can take weeks or months for it to improve. An analogy is like a garden hose that has been trapped under the garage door for a long time. Even after the garage door is lifted, the hose may still be indented and the normal flow of water may not resume straight away. It may take a while for the hose to return to its normal shape and deliver a strong, steady flow. 

What to look out for

  • Continued drainage from the wounds that does not stop after 1 week

  • Suddenly deterioration in pain when previously pain has been improving

  • Sudden numbness or weakness of the hand/fingers when previously it has been improving

  • If any of the above is noted, please contact Dr Kemble Wang's team. 

©2020 Kemble Wang Orthopaedics

 

Disclaimer: All information provided on this webpage should be considered as general guidelines. Actual practice and (expected) outcomes may differ in your case. The contents has been created online for information purposes only. It is not intended to be a substitute for professional medical advice.