Ulnar Deep Muscle Transposition for Chronic Pain

The ulnar nerve extends from the shoulder to the hand, and is responsible for sensation in the fingers, as well as muscle control in the hand and forearm. In certain circumstances, this nerve can become abnormally compressed in the area of the elbow or wrist, a condition called ulnar nerve entrapment. Relief of the numbness and pain of chronic nerve entrapment may require surgical transposition, or moving, of the nerve to a new location within the arm.

Ulnar Nerve Entrapment in the Elbow

• Nerve entrapment in the elbow occurs when the pathway for the nerve, a soft-tissue channel called the cubital tunnel, is compressed or compromised. If you are suffering from this form of ulnar entrapment, your symptoms may include numbness and tingling in your pinky and ring fingers, hand weakness and a dull, achy pain on the inside of your elbow. See your doctor if these symptoms are present.

Surgery for Elbow Entrapment

• If your pain is chronic---and does not resolve after more conservative treatments such as rest, lifestyle modification, anti-inflammatory medication and physical therapy---your doctor may recommend surgery to create free passage for the ulnar nerve. The particular method your surgeon chooses to achieve this goal depends partially on the amount of damage present.

  All methods of ulnar nerve relief at the elbow require an incision to give surgeons access to the cubital tunnel. If your chronic nerve compression is relatively minor, your surgeon may not move the ulnar nerve at all; instead, he may simply remove the top of the cubital tunnel to allow the nerve more space. If damage is more extensive, your surgeon will relocate, or transpose, the nerve. The typical procedure performed is called an anterior transposition, which involves moving the ulnar nerve from behind the elbow to a position in front of the elbow. Depending on your particular condition and his personal preferences, your surgeon will relocate the nerve in one of three places.

  In subcutaneous transposition, your nerve is moved to a newly formed tunnel between the flexor muscles of the forearm and the fat layer beneath the skin. In intermuscular transposition, your nerve is moved to a new tunnel formed within the body of a flexor muscle. In submuscular transposition, your nerve is moved to a new tunnel created below one of the flexor muscles.

Surgery for Wrist Entrapment

• Ulnar nerve repair may also be performed for compression at the wrist. Symptoms of wrist compression are similar to elbow compression. If you have wrist nerve compression that does not respond to more conservative treatment, your surgeon may open up the top of the ulnar nerve passageway in this area, called Guyon's canal. In some cases, wrist compression may be caused or worsened by the presence of abnormal tissue sacs known as cysts. If so, these will be removed as well.

Recovery

• Surgery for nerve compression relief is typically done on an outpatient basis, and your recovery time will vary with the particular procedure performed. Recovery will be greatly improved by physical therapy, and only after therapy can the success of surgery be fully judged.