Ulnar Nerve Decompression
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What is it?
Ulnar nerve decompression is surgical procedure designed to explore the region around the elbow through which the ulnar nerve passes. The ulnar nerve is responsible for the “funny bone” phenomenon when you hit your elbow. Damage to this nerve, usually from some form of trauma or other injury or in rare instances a tumor, can lead to a permanent sensation of numbness or tingling similar to the “funny bone” sensation. Additionally, damage to the nerve can lead to loss of function in the muscles of the hand supplied to the ulnar nerve. Diagnosis of a peripheral nerve injury is usually confirmed by diagnostic tests to evaluate the conduction of electrical impulses through the ulnar nerve and to confirm the neuropathy is isolated to the ulnar nerve.
What is its goal?
The goal of ulnar nerve surgery is to explore the nerve in the region of the elbow and remove any compressive forces on it that are causing the neuropathy (dysfunction of the nerve). The region of the elbow contains several passages through muscle and connective tissues that may potentially compress the ulnar nerve as it passes through. In particular, the triceps muscle in the upper arm, the bony groove in the elbow where the ulnar nerve passes, and another passage through muscle in the forearm, are the most common sites where the ulnar becomes compressed. By exploring the elbow region all three of these sites can be explored and any compressive forces on the ulnar nerve can be released.
How is it done?
Usually patients are brought to the operating room for ulnar nerve surgery. Most patients do not require being put fully to sleep with general anesthesia for this procedure. Patients are usually given intravenous sedation medication to keep them resting and comfortable. Local anesthetic in the elbow region is also used to limit pain. Occasionlly a nerve block can be applied to the entire arm that will be explored. An 3-4 inch incision is made along the elbow in between the two bony prominences that are on the same side of the arm as the thumb. The incision is taken deep enough to be able to visualize the ulnar nerve. The nerve is then explored into the upper arm to the point that is passes through the triceps muscle. It is explored in the forearm until it passes through a muscle in the forearm. Once the entire nerve has been explored through this region and is seen to be well decompressed, the overlying connective tissue and skin are closed with stitches. The patient’s arm is wrapped loosely. We generally recommend that patients keep their arms elevated for the first 24-48 hours to prevent swelling. The sutures in the skin are removed in 10-14 days.
What are the risks?
The major risks of the operation are bleeding and infection. The risk of either of these complications is usually less than 5%. Patients are given antibiotics before the procedure to limit the risk of infection, and the procedure is performed in careful fashion to limit damage to blood vessels that may cause significant bleeding. Additionally, even with exploration and decompression of the ulnar nerve, there is the risk that, in some cases, surgery will fail to improve a patient’s symptoms of ulnar neuropathy.
How long will I stay in the hospital?
Patients who have ulnar nerve surgery are usually brought to the hospital early in the morning on the day of surgery and most go home the same day.