Ulnar nerve release or decompression surgery is a procedure for treating cubital tunnel syndrome. This is also known as ulnar nerve entrapment or pinched ulnar nerve.
The ulnar nerve goes around the back of the inner side of the elbow, which is also sometimes called the ‘funny bone’. It further goes through a tight tunnel between the muscles of the forearm. If this tunnel becomes too tight, it may cause pressure on the nerve. This can result in numbness in the ring finger and little fingers. The irritation or compression of the ulnar nerve irritation can cause pain, a tingling sensation, discomfort, and even weakness in the hand of the patient. The narrowness of the cubital tunnel and its minimal soft tissue make the ulnar nerve very vulnerable to irritation.
This surgery aims to prevent any further damage to the ulnar nerve and to improve the patient’s symptoms. If a patient undergoes the operation early enough, the numbness in their hand can get better. If the symptoms are mild and occur mostly at night, it often helps to use a splint that can hold the elbow straight while the patient is in bed.
Ulnar nerve decompression surgery can be performed under either general anaesthesia or regional anaesthesia as day surgery. A patient is usually expected to be operated on and released from the hospital the same day.
The procedure involves making an incision over the back of the elbow joint. The surgeon identifies the ulnar nerve and traces it up and down the arm. The surgeon will then release any soft tissue or bony structures that are seen to be irritating the ulnar nerve.
Usually, the nerve is left in its original groove. However, if there is a lot of scarring in the area, the surgeon can move the nerve in to a new groove created by them. This procedure is known as transposition of the ulnar nerve.
The surgeon then cauterises any bleeding and seals the wound using dissolvable sutures. The procedure usually takes less than an hour, more specifically between 30-45 minutes.
The goal of both these techniques is to increase the size of the cubital tunnel, to relieve the pressure on the ulnar nerve.
Cubital tunnel release surgery is typically considered a safe and effective procedure. Some of the side effects or complications specific to this surgery include:
The surgeon may advise resting the affected arm in a sling for a few days. The patient can gently exercise the fingers, elbow, and shoulder to prevent any stiffness. However, a patient must consult their healthcare team or GP for advice based on their case.
Patients can return to most of their everyday activities soon after the surgery. However, the recovery time from surgery varies for each patient. It may take anywhere from several days to weeks.
Some symptoms such as numbness and tingling may improve quickly or may take up a few months to go away. Some symptoms may persist post-surgery if the nerve compression was severe or was left untreated for a long time. If the procedure involved operation on any nearby bone or relocation of the ulnar nerve to a new groove, then the recovery time of the patient may get extended.
Symptoms are expected to continue improving for up to 18 months post-surgery. The procedure can subsequently enhance comfort and mobility of the hands by providing relief in pain and numbness and preventing any permanent nerve damage.
The most common cause of ulnar nerve entrapment is compression on the ulnar nerve. This compression may be because of any of the following reasons:
The patient is not advised to drive until 7-10 days after the procedure.
Post-surgery precautions to be taken are as follows:
Physical therapy goes on at a slower rate post-ulnar nerve surgery. Although the time required for recovery varies from one patient to the other, many people do require physiotherapy for at least three months.
Post-surgery, a splint is usually applied to the elbow of the patient holding it in a bent position. The patient is advised to wear the splint for at least 2 weeks. This allows the incision site to heal properly and for the ulnar nerve to set into its new position. Complete recovery varies, but on an average, it does take 3 to 6 months.