Treatment - How can I help

Ulnar Nerve Entrapment

Other popular names

Who does it affect?

Anyone

Why does it happen?

The ulnar nerve is the "funny bone" nerve which travels between the tip of the elbow and the inner elbow bone.  At this site it can be "pinched" by normal structures or swollen structures after injury.  This pinching is referred to as entrapment. 

Symptoms

When ulnar nerve entrapment occurs, numbness and tingling of the little and ring finger of the hand may be felt.  Pain may occur in the entire forearm, usually the inner side.  Hand dexterity can be affected.  Sometimes, the numbness is reproduced by elevating the hand.

Diagnosis

This is a common condition and can be easily diagnosed by your consultant.

Non-surgical treatment

Treatment consists of avoiding repeated trauma or pressure to the elbow area and resting the elbow joint.  Occasionally, ice can help.

Surgical treatment

In severe cases, surgical repositioning of the ulnar nerve can be required.  This relocates the ulnar nerve to a position where it will not be continually compressed by the surrounding structures.  Surgery is carried out as a day case procedure usually either under local or regional anaesthetic and takes about 15 minutes.

Local anaesthetic is given.  Once numb the surgery is performed through a 5cm incision, the skin is incised and then the underlying fat is retracted.  At the base of the wound is the common extensor origin (the muscle/bone junction for the muscles that cock the wrist backwards).  This area is released off the bone and the underlying bone surface is nibbled to provide a healthy bed for the tendons to stick back down.  The skin is sutured and a bulky dressing is applied.

Post-surgery rehabilitation

You can go home soon after the operation.  The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The arm should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers and elbow from day 1. The dressing will be removed soon after your operation.  The wound is cleaned and redressed with a simple dressing.  Avoid forced gripping or lifting heavy objects for 2-3 weeks.  The sutures are removed at about 10 days.  You should notice an improvement in symptoms within a few weeks but the final result may take some 3-6 months.

Return to normal routine

Keep the wound dry until the stitches are out at 10 days.

Return to driving: The hand needs to have full control of the steering wheel and left hand the gear stick.  You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.

Return to work: Everyone has different work environments.  Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament.  You will be given advice on your own particular situation.

Risks

Overall over 95% are happy with the result. However complications can occur.

General risks (less than 1% each):

Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any elbow surgery from a minor procedure to a complex reconstruction).
Specific risks:

Failure to completely resolve the symptoms (approximately 1%) - this may be due to failure to completely release the area. This is rare, but may be released again.

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