The ulnar nerve is a key component of the nervous system, responsible for sensation and motor function in the forearm and hand, particularly the ring and little fingers. When this nerve becomes compressed or irritated, it can cause discomfort, numbness, and weakness. In many cases, ulnar nerve surgery becomes a necessary intervention to alleviate symptoms and restore full function. This comprehensive guide explains what ulnar nerve surgery involves, when it’s needed, and what patients can expect from the procedure and recovery.
What is the Ulnar Nerve and Why Is It Important?
The ulnar nerve originates in the neck, travelling down the arm and passing through the elbow at a narrow tunnel-like passage called the cubital tunnel. It continues down into the hand, controlling fine motor movements and providing sensation to parts of the hand. Because of its location, the ulnar nerve is vulnerable to compression or injury, especially at the elbow.
The integrity of this nerve is essential for hand strength, coordination, and sensation. Damage or pressure on the nerve can lead to symptoms that affect day-to-day activities, such as gripping objects, typing, or simply feeling textures.
Causes of Ulnar Nerve Compression
Several factors can cause irritation or compression of the ulnar nerve:
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Cubital tunnel syndrome: The most common cause, where the nerve is compressed at the elbow.
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Prolonged elbow flexion: Holding the elbow bent for long periods causes increased pressure.
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Repetitive stress or trauma: Frequent elbow movements or direct impacts can injure the nerve.
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Anatomical abnormalities: Bone spurs, cysts, or scar tissue near the nerve.
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Elbow fractures or dislocations: Structural changes may impinge the nerve.
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Systemic conditions: Diabetes or arthritis may predispose individuals to nerve issues.
Symptoms That May Indicate Ulnar Nerve Issues
Early recognition of ulnar nerve problems is critical for successful treatment. Common symptoms include:
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Tingling or numbness in the ring and little fingers, often described as “pins and needles”.
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Weakness in grip and loss of fine motor skills in the hand.
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Pain or aching on the inside of the elbow.
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A feeling of the hand “falling asleep,” especially at night.
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In advanced cases, muscle wasting and permanent loss of sensation.
If you experience one or more of these symptoms — especially if they worsen over time — it is advisable to consult an orthopaedic specialist promptly.
Diagnosis and Initial Treatment
Your orthopaedic surgeon will perform a thorough clinical examination, reviewing your symptoms, checking muscle strength, and assessing sensation. Diagnostic tests like nerve conduction studies or electromyography (EMG) may help confirm nerve damage and its severity.
Initial treatment strategies usually focus on conservative management, including:
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Avoiding sustained elbow bending positions.
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Wearing splints or braces, especially at night.
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Anti-inflammatory medications.
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Physical therapy exercises to improve nerve-gliding and reduce compression.
If symptoms persist or worsen despite these measures, surgical intervention may be recommended.
What is Ulnar Nerve Surgery?
When conservative treatments fail or nerve compression is severe, ulnar nerve surgery offers a reliable solution to relieve pressure and prevent permanent nerve damage.
The main surgical approaches include:
1. Ulnar Nerve Decompression (Cubital Tunnel Release)
This procedure involves making a small incision near the elbow and cutting the ligament compressing the nerve. This releases the nerve and widens the cubital tunnel, reducing pressure and irritation.
2. Ulnar Nerve Transposition
Sometimes, the nerve is moved to a new position in front of the elbow to prevent it from being stretched or compressed when the elbow bends. There are subtypes:
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Subcutaneous transposition (nerve moved just under the skin)
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Submuscular transposition (nerve moved beneath muscle layers)
3. Medial Epicondylectomy
This involves removing part of the bony prominence (medial epicondyle) to reduce pressure on the nerve.
The choice of technique depends on individual anatomy, severity of compression, and surgeon preference.
The Surgical Procedure
Ulnar nerve surgery is usually performed under regional or general anaesthesia and generally takes around 30-60 minutes. It is often done as a day-case surgery, meaning you can go home the same day.
During surgery, the orthopaedic surgeon carefully exposes the nerve, relieves compression, and ensures it is properly positioned to avoid further irritation. After the procedure, the incision is closed with absorbable stitches or sutures, and a bandage is applied.
Recovery and Rehabilitation
Immediate Post-Op Care
After surgery, patients typically wear a sling or protective dressing for a few days to minimise movement and aid healing. Pain and swelling are managed with medications.
Rehabilitation
Early mobilisation is encouraged to prevent stiffness. Gentle movement exercises usually begin within days of surgery. Physical therapy plays a crucial role in strengthening the arm, restoring full range of motion, and improving nerve function.
Timeline for Recovery
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First 2 weeks: Avoid heavy lifting and strenuous arm use.
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4 to 6 weeks: Gradual increase in activities; continued therapy.
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3 months: Most patients experience significant symptom relief.
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Up to 12 months: Full recovery of nerve function can take several months.
Patients are advised to avoid repetitive elbow bending during the healing phase to protect the nerve.
Risks and Considerations
As with all surgeries, ulnar nerve surgery carries some risks:
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Infection
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Nerve injury or incomplete relief of symptoms
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Scar tissue formation
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Persistent numbness or weakness in some cases
However, when performed by an experienced orthopaedic surgeon, complication rates are low and patient outcomes are excellent.
Choosing the Right Surgeon
Ulnar nerve surgery requires specialised knowledge of nerve anatomy and microsurgical skills. Dr Jagwant Singh, a renowned upper limb orthopaedic surgeon based in London, has extensive experience in treating nerve compression disorders with advanced surgical techniques. His personalised approach ensures every patient receives tailored care to achieve the best possible outcome.
When to Seek Help
Don’t ignore signs of ulnar nerve compression — early intervention can prevent permanent nerve damage and disability. If you suffer from persistent tingling, numbness, or hand weakness, book a consultation with a specialist who can provide an accurate diagnosis and recommend the appropriate treatment.