Ulnar nerve decompression and transposition

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The ulnar nerve is the nerve that travels in the back of the elbow through a passageway called the cubital tunnel. When the ulnar nerve is compressed or entrapped, the nerve can become inflamed leading to pain and numbness in the hand which is called  cubital tunnel syndrome. The ulnar nerve decompression and transposition aim to release pressure and stress on the ulnar nerves running in the cubital tunnel.

Signs and symptoms of Ulnar nerve entrapment

The signs and symptoms of ulnar nerve compression include.
  • Aching pain in the hand
  • Numbness, tingling, pain in the little finger and ring finger and inside the hand. These symptoms occur with prolonged resting on the elbow and repetitive elbow bending
  • Weakness in the hand grip
  • Pain in the elbow and inside of the forearm

Causes of the Ulnar nerve decompression

Various causes of Ulnar Nerve entrapment are-
  • Trauma
  • Repetitive motion
  • Frequent pressure on the elbow
  • Medical conditions like bone spurs, cysts, or tumors in the cubital tunnel led to pressure and irritation of the ulnar nerve 

Overview of cubital tunnel syndrome treatment:

Most of the cases of ulnar nerve entrapment can be treated with medicines, physiotherapy and elbow splint. In some cases when the pain is not responding to the medicines and physiotherapy or if there is significant weakness of the hand muscles, surgical intervention is required.
Surgery can be of two types namely
  • Ulnar nerve decompression surgery- where the thickened ligament is divided and any tumor or bony spur compressing the nerve is removed.
  • Ulnar nerve decompression and transposition- This procedure is especially indicated when there is deformity of the elbow joint causing stretching of the nerve in flexed position.

The steps of Ulnar Nerve Decompression and Transposition

For this procedure, the patients are usually given sedation and regional anesthesia. A regional nerve block leads to temporary paralysis of the arm for about 3-4 hours. An incision is made long enough to decompress the ulnar nerve completely and then the entire ulnar nerve is exposed to relieve the compression of the nerve. Once this is done, the nerve is shift to the front of the elbow and secured below the skin (subcutaneous ulnar nerve transposition), or fascia (sub fascicular ulnar nerve transposition) or muscle (submuscular ulnar nerve transposition). The surgical wound is closed in layers. Then, the wound is dressed and the patient’s hand is wrapped loosely. The patients are recommended to stay in the hospital for the next 24-48 hours after the ulnar nerve surgery to monitor the recovery.

Risks and complications of Ulnar nerve Decompression and Transposition surgery

The Ulnar nerve decompression and transposition is a safe procedure and most of the patients don’t face any complications but some do. The potential risks and complications of this surgery might include-
  • Infection 
  • Bleeding 
  • Elbow stiffness
  • Nerve damage causing permanent numbness in the hands or wrist
  • Pain at the treatment site
  • Symptoms unresolved after the surgery 

If you have been suffering from ulnar nerve compression and your doctor has recommended you to undergo a surgical procedure, then get a second opinion from another neurosurgeon to explore all the available treatment options.

Frequently Asked Questions

Ulnar nerve decompression involves releasing the ligament or fibrous tissue compressing the ulnar nerve at the elbow (cubital tunnel) without moving the nerve. Transposition involves surgically relocating the nerve to the front of the elbow to eliminate tension. Transposition is used when the nerve is unstable or decompression alone is insufficient.

Sensory recovery after ulnar nerve surgery typically begins within weeks, with progressive improvement over 3–12 months. Motor recovery (hand strength and intrinsic muscle function) is slower and may take up to 12–18 months in severe cases. Earlier surgery generally leads to better and faster nerve recovery.

After ulnar nerve surgery, avoid resting on or bending the elbow for prolonged periods for at least 4–6 weeks. A splint may be used initially to protect the elbow. Avoid heavy lifting for 4–6 weeks. Hand therapy is recommended to restore grip strength and fine motor function during recovery.