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Ulnar nerve entrapment

Treatments for ulnar nerve entrapment

If conservative treatments, such as night splints, have failed to fix the symptoms of ulnar nerve entrapment then your Consultant may suggest ulnar nerve release decompression. The procedure is usually the first and most suitable surgical solution for ulnar nerve entrapment, known as cubital tunnel syndrome. It works by reducing friction or pressure on the ulnar nerve by cutting and separating the overlaying ligament, allowing the nerve to pass through the cubital tunnel more freely.

Conservative treatment methods

If you are experiencing mild to moderate symptoms, your Consultant may recommend non-surgical treatment such as splinting, neural glide exercises or mobilisation of the joint by a therapist. It is also helpful to avoid activities where the elbow is bent for long periods of time. Anti inflammatory medications such as ibuprofen may help reduce swelling around the nerve. Steroid injections are rarely used to treat cubital tunnel syndrome due to the danger of nerve injury.

Splinting is where an elbow brace is worn every night for a period of three months to keep your elbow straight while asleep.

Neural glide exercises help the ulnar nerve slide through the affected joints and help prevent stiffness. Improvement usually takes about 4 weeks.

 

 

Surgical treatment methods

Your Consultant could recommend ulnar nerve release surgery if you have severe or long-standing ulnar nerve entrapment where nonsurgical treatment has failed to improve symptoms or prevent the nerve from further deterioration.

Your Schoen Clinic Consultant will perform an assessment to find out if you are a suitable candidate for ulnar nerve decompression surgery.

 

What happens during ulnar nerve release surgery?

The operation normally takes 30 to 45 minutes and is usually done under a general anaesthetic, but can also be done under a local anaesthetic. Blood flow to the arm is stopped using a tourniquet.

Open ulnar nerve decompression surgery

If you're undergoing open ulnar nerve decompression surgery, a 3 inch incision is made on the ligament covering the ulnar nerve on the inner angle of your elbow and any soft tissue causing the compression is removed, releasing the nerve. Your surgeon will put the elbow through a series of motions to determine whether the nerve is unstable or overly tight below the elbow. Once they are satisfied of an effective, unhindered range of motion in the elbow, the wound is closed with stitches and dressed with a padded sterile dressing.

Keyhole ulnar nerve decompression surgery

If your elbow problem is suitable for endoscopic or keyhole surgery the incision is much smaller. An endoscope with a camera at one end is inserted into your elbow. Your surgeon will be able to see inside your joint using the endoscope and will perform ulnar nerve release surgery using miniature surgical instruments. The wound is closed using surgical tape instead of stitches and covered with a sterile padded dressing. This type of surgery is less intrusive than open surgery and usually results in a faster recovery as there is less disruption to the soft tissue surrounding the elbow joint.

 

Risks and possible complications of ulnar nerve release surgery

This type of surgery has a low risk of short-term complications overall. Ulnar nerve instability is the most common complication and is associated with severity and duration of pre-surgery symptoms. Your Consultant will discuss options for further treatment. Other possible complications include:

  • Inadequate nerve decompression.
  • Injury to the nerve, vessel or tendon.
  • Infection, though this is rare. Contact your Consultant if you experience swelling, redness, throbbing pain, leakage of fluid and perhaps high temperature.
  • Wound leakage can occur for up to 3 days after surgery and can normally be stopped during that time by applying gentle pressure to the dressing. Contact your Consultant if bleeding persists.
  • Persistent pain, including reflex sympathetic dystrophy (RSD) and complex regional pain syndrome (CRPS). This can be treated with pain medication and hand therapy.
  • Nerve irritation resulting in weakness, numbness and tingling. This usually goes away 6 weeks after surgery.
  • Persistent stiffness which may be treated with physical therapy.