Ulnar Nerve Transposition

(Ulnar Nerve Decompression)

Ull-narr Nurv Trans-po-zi-shun

Definition

Ulnar nerve transposition is a surgery to relocate a nerve at the elbow and create a new path for the nerve to sit in.

Reasons for Procedure    TOP

Ulnar nerve transposition is done to treat cubital tunnel syndrome (CTS), also called ulnar nerve entrapment at the elbow. The cubital tunnel is an area on the inside back of the elbow. It is often called the “funny bone”. A major nerve of the arm, called the ulnar nerve, passes through this tunnel just behind the bump of the inner elbow. Sometimes structures of this tunnel can swell and put pressure on the nerve. The pressure causes CTS, a range of symptoms such as numbness, tingling, or weakness.

An ulnar nerve transposition helps relieve the pressure on the nerve by relocating the nerve.

The surgery can help relieve many symptoms. If the nerve has been badly injured, some symptoms may remain.

The Hand

Pressure on the ulnar nerve can cause problems in the pinky and ring fingers of the hand.
Copyright © Nucleus Medical Media, Inc.

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Excess bleeding
  • Adverse reaction to anesthesia
  • Infection
  • Blood clots
  • Soreness in throat
  • Nausea and vomiting
  • Nerve injury
  • Symptoms do not resolve with surgery

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

What to Expect    TOP

Prior to Procedure

Before the surgery, your doctor may:

  • Do a physical exam and review your medical history
  • Order blood tests and have images taken

Leading up to your procedure:

  • Certain medications may cause complications during the procedure or recovery. These medications may need to be stopped up to 1 week before the procedure. Talk to your doctor before the procedure about all medications you are taking.
  • Do not start any new medications, herbs, or supplements without talking to your doctor.
  • Be sure that you have a ride to and from the hospital the day of your surgery.
  • Arrange for help at home as you recover.
  • The night before, eat a light meal. Do not eat or drink anything after midnight unless told otherwise by your doctor.

Anesthesia

This procedure may be done using:

  • General anesthesia—you will be asleep
  • Local anesthetic—the area being operated on will be numbed

Description of the Procedure    TOP

An incision will be made near the inside elbow. The ulnar nerve will be located and moved from behind the elbow to the front. A new area will be created for the nerve to sit in. Depending on your specific needs the nerve may be placed in 1 of the following:

  • Under the skin and fat but above the muscle
  • Within the muscle
  • Under the muscle

The doctor will discuss the options with you before the surgery.

How Long Will It Take?    TOP

About an hour

Will It Hurt?    TOP

Anesthesia will prevent pain during the procedure. After the anesthesia wears off, there will be some discomfort at the incision. The changes to the nerve may also cause some symptoms during recovery. Pain medication will be given to help manage pain after the procedure.

Post-procedure Care    TOP

At the Care Center

You will be monitored in a recovery area until you are ready to go home. Right after the procedure, the staff may:

  • Monitor your recovery until you are ready to go home.
  • Elevate your arm using pillows.
  • Apply ice to the area to reduce swelling.
  • Apply a splint, bandages, and dressing to support the area.

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

At Home

It will take a few weeks for the incision and involved muscles to fully heal. Physical activity will need to be limited during recovery:

  • Your doctor will refer you to a physical therapist. Exercises will help restore strength and range of motion.
  • Avoid heavy lifting or other strenuous activity until your doctor says it is okay.
  • Be sure to follow your doctor’s instructions.

Call Your Doctor    TOP

Call your doctor if any of these occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Discoloration of the fingers of the affected hand
  • Tingling and numbness of the affected hand
  • Pain that you can't control with the medications you've been given
  • New or worsening symptoms

If you have an emergency, call for medical help right away.

RESOURCES:

The National Institute for Occupational Safety and Health
http://www.cdc.gov/niosh
Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES:

Canadian Centre for Occupational Health and Safety
http://www.ccohs.ca
Canadian Orthopaedic Foundation
http://www.canorth.org

References:

Cubital tunnel syndrome. American Society for Surgery of the Hand website. Available at:
...(Click grey area to select URL)
Accessed June 2, 2016.
Jaddue D, Saloo S, et al. Subcutaneous vs. submuscular ulnar nerve transposition in moderate cubital tunnel syndrome. Open Orthop J. 2009;3:78-82. Available at:
...(Click grey area to select URL)
Accessed June 2, 2016.
Liu CH, Wu SQ, Ke XB, Wang HL, Chen CX, et al. Subcutaneous versus submuscular anterior transposition of the ulnar nerve for cubital tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials and observational studies. Medicine. 2015;94(29):e1207. Available at:
...(Click grey area to select URL)
Accessed June 2, 2016.
Soltani AM, Best MJ, Francis CS, Allan BJ, Panthaki ZJ. Trends in the surgical treatment of cubital tunnel syndrome: an analysis of the National Survey of Ambulatory Database. J Hand Surg. 2013;36(8):1551-1556.
Ulnar nerve entrapment at the elbow (cubital tunnel syndrome). OrthoInfo—American Academy of Orthopaedic Surgeons website. Available at:
...(Click grey area to select URL)
Updated September 2015. Accessed June 2, 2016.
Ulnar nerve entrapment of elbow. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated May 6, 2014. Accessed June 2, 2016.
Last reviewed June 2016 by Laura Lei-Rivera, PT, DPT, GCS
Last Updated: 6/2/2016

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