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Treatments > Ulnar Nerve Decompression

Ulnar Nerve Decompression

Your ulnar nerve goes around the back of the inner elbow, then through a tight tunnel between your forearm muscles. Increased pressure on this nerve can result in numbness in your little finger and ring finger.

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Symptoms

When you bash your elbow and strike your ‘funny bone’ it is actually the nerve that you have knocked. Tingling is felt in the little and ring fingers and is often fairly constant. In severe cases weakness and loss of dexterity of the hand with thinning of the muscles can also occur resulting in numbness of these fingers. The condition usually occurs spontaneously, or occasionally there is a specific injury.

Some people find sleeping with the elbow bent causes symptoms; changing your sleeping position can relieve them.

The condition can be confused with compression of nerves in the neck and the hand, so electrophysiological studies may be done to test the nerve conduction and confirm the problem is at the elbow.

In the majority of people, the symptoms are due to mechanical compression of the nerve, and surgery is required. The operation is worthwhile because it has a reasonable success rate, recovery is not particularly troublesome, and the serious complication rate is very low. If the nerve has been irreversibly damaged due to long-term compression the symptoms will not fully recover.

Risks

  • The operation does not always work, particularly if the nerve is badly damaged and there are constant symptoms or muscle wasting pre-operatively.
  • The nerve is injured during or by the operation, causing increased numbness and pain (rare).
  • Due to injury to little nerves that run under the skin there is sometimes an area of numbness on the back of the arm beyond the incision. If this does occur, it will be permanent but will not cause you any problems.

General surgery risks

With planned operations complications are unusual. Statistically about 5% of patients have a post-operative problem, the vast majority of which are temporary and do not affect the final result.

Infection. The signs may develop after a few days, with increasing pain, swelling and redness. Treatment with antibiotics is usually sufficient. Very occasionally an infection can be severe and cause major problems.

Wound healing problems. Excessive bleeding, causing a painful swollen wound (haematoma) or delayed healing may slow down the recovery. A few people react to the dissolving suture material, and this can lead to localised areas of tenderness and swelling that persist for a couple of months.

Swelling and stiffness. Occasionally the swelling is severe, prolonged and associated with pain, due to the development of the poorly understood condition called complex regional pain syndrome (CRPS). This can be treated with physiotherapy and pain tablets. Very rarely it leads to long-term stiffness and disability, compromising the function of the hand permanently.

Surgery

The operation is usually performed as a day case under general anaesthetic. You must come into the unit having eaten nothing for six hours and you will only be allowed clear fluids for the two to six hours before your procedure.

You will be able to go home the same day and you must arrange for someone to drive you.

The consultant will make an incision on the inner side of the elbow. The tunnel that the nerve runs in is opened, freeing the nerve.

The incision will be closed with dissolving stitches and the wound is dressed, leaving reasonable elbow movement immediately after the operation.

In most cases, the nerve is simply decompressed but occasionally, an additional procedure may be performed (such as removing some bone from the inside of the elbow or moving the nerve to a different position). These will have been discussed with you before the operation.

Recovery

It is important to follow this advice for the first 24 hours after a general anaesthetic:

  • Someone should stay with you until the general anaesthetic has worn off.
  • Do not drive, operate machinery, or do any potentially dangerous activities (like cooking) until you have fully recovered feeling, movement and co-ordination.
  • Do not sign any legal documents or drink alcohol.

The arm and hand should be moved and used as normally as possible.

The dressings can come off after about 10 days and you can get the wound wet from 14 days after surgery. Any knots from the dissolving stitches should be rubbed off after two weeks when you are washing.

Painkillers may be needed for the first few days, but physiotherapy is not usually needed.

The recovery from tingling is variable, but generally there are two phases; a very rapid improvement over the first 24 hours, and then if there are still symptoms, much slower further improvement over many months. If there is constant numbness or weakness pre-operatively then the recovery is always over a long period (up to 18 months) and may never be complete.

The scar will remain tender for at least two months, and it should be massaged with cream (lanolin, E45, Double Base) regularly.

The operation is relatively superficial, with no muscles being cut, so return to near normal function should be possible in a matter of three weeks.

Ability to drive after the procedure varies from person to person. It is up to you to decide when you feel comfortable to do so. It will probably be less than a week if the right elbow is operated on, but it may be longer for the left because of the need to use the hand brake.

Manual workers normally need about three weeks off work, but office employees will be able to return sooner.

When to seek further help

Signs of wound infection may develop after a few days, with increasing pain, swelling and redness. Seek advice from your GP as treatment with antibiotics is usually sufficient.