Ulnar Nerve Transposition

What is it?

Ulnar nerve transposition is a procedure that moves the ulnar nerve from behind the medial condyle of the elbow to a better position so that it is no longer irritated or pinched. This is done in individuals where the ulnar nerve is being compressed against the medial epicondyle (inside of the elbow), which causes the function of the nerve to be compromised. This may cause pain at this site or tingling and numbness in the  forearm and fingers.

Proper diagnosis of ulnar nerve entrapment requires the expert attention of an experienced physician who will determine if the symptom is primary or if it is secondary. If it is a secondary symptom, it could be arising out of a more complicated disease like diabetes. Diagnosis will include:

• A comprehensive clinical exam. Your doctor will ask you to perform certain tasks with your hands so he or she can determine if ulnar nerve entrapment is a possible diagnosis for your pain. 
• Complete medical history 
• Electrodiagnostic studies (EMG) to study nerve conduction within your hands and wrists

What are the treatment options?

Depending on the severity of your ulnar nerve entrapment, your physician may recommend the following:

• Occupational therapy to strengthen the ligaments and tendons in the hands and elbows 
• The daily use of nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers to help reduce pain and inflammation 
• Wearing splints to help immobilize the elbow When physical therapy and other forms of non-surgical treatment fail, nerve entrapment surgery is the best option to restore function and alleviate pain.

Risk Factors

The following factors may increase your likelihood of having additional pressure on the ulnar nerve at the medial epicondyle:

• learning on the elbow for many hours 
• fracture in the medial epicondyle 
• conditions such as rheumatoid arthritis or carpal tunnel syndrome which cause entrapment of the nerve

What to Expect

After Procedure

After surgery a splint will be applied to the elbow holding it in a bent position. This will be worn anywhere from 2-4 weeks to allow the incision to heal and let the ulnar nerve set into its new position. Full recovery will vary, but on average it can take anywhere from 3 to 6 months.

Discharge Instructions

Diet

• You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Hand Care & Bathing

• Keep your dressing, splint, cast and/or sling in place until your first post-op visit. 
• Dressing will be changed at your first post-op appointment. 
• Tegaderm dressing will be placed which will allow you to shower immediately. 
• No bath or swimming until the bandages are removed. 
• If the dressings become loose or fall off replace with over the counter water proof bandages. 
• Keep incision dry until sutures are removed.

Elevation and Circulation

• Elevate the extremity on pillows with fingers point toward the ceiling as much as possible for the first 3-5 days. 
• After these first few days, continue to elevate as needed in order to reduce swelling. 
• To encourage circulation and decrease swelling, wiggle your fingers, thumb and wrist several times each hour.

Cold Therapy

• To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48 hours and then as needed to help control pain and swelling. 
• To avoid frostbite, place a towel or t-shirt between the ice pack and your skin. 
• It is not necessary to use ice while sleeping. 
• We recommend the use of a cold therapy unit, which is often an out of pocket expense. The advantage of this unit is that the temperature can be regulated, allowing for continuous use for several hours at a time.

Pain Medication

• Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol. 
• While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off. 
• No driving while taking any narcotic pain medication! 
• The pain medication may cause some nausea so take it with food. 
• The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.

Follow-up Care

• Watch for temperature > 101.5F, persistent numbness and tingling, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room. 
• Please make sure to follow instructions given to you by your physician, they may have specific instructions to your care.
• If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.

Rehabilitation Plan - Exercises

Your doctor will order physical or occupational therapy in order to restore full range of motion at the elbow and increase strength. Stretching and toning exercises will also be performed by your therapist to restore normal function as well as to reduce swelling and reduce pain.