What is ulnar neuropathy?
Ulnar neuropathy refers to pain, tingling, or numbness in one or both hands resulting from compression of the ulnar nerve, almost always at the elbow (rarely at the wrist). The ring and little fingers are generally affected by numbness, with pain often experienced around the inside of the elbow and forearm.

This problem is diagnosed by a combination of clinical assessment and nerve conduction studies.

In some cases, ulnar neuropathy may follow direct trauma to the elbow and/or a fracture in this region.

How is ulnar neuropathy treated?
Sometimes the symptoms settle on their own, with analgesia and modification of activity (avoidance of repetitive elbow movements and direct pressure over the inside of the elbow). When this does not occur, surgery may be indicated.

How is the surgery performed?
A week or two before surgery you will have some blood tests to check that your blood is clotting correctly, among other things. You will be admitted to hospital an hour or two before surgery. You should not eat or drink anything for 6 hours before this.

This operation is performed frequently by neurosurgeons, and is known as an ulnar neurolysis. It involves making a small incision, or cut, over the inside of the elbow. Using magnification, your surgeon will carefully divide the band of tissue which is constricting the nerve. Sometimes there is significant scar tissue around the nerve, and this is also divided. Removal of a small amount of bone (medial epicondylectomy) and/or repositioning of the nerve itself (ulnar transposition) are rarely required, and usually only in the context of a failed neurolysis procedure or significant elbow deformity.

An ulnar neurolysis typically takes 20-40 minutes, and dissolving sutures are generally used. This procedure is usually under a light general anaesthetic, and the patient returns home on the same day.

What happens after the operation?
You will have to wear a firm dressing for 4 days (your GP should check your incision at that stage), and should keep your hand elevated for the first 48 hours. Your wound will then be reviewed again around 12 days after surgery by your GP or the Precision Neurosurgery Practice Nurse. If dissolving stitches are used, these will not need to be removed.

You will be able to use your hand in a progressively normal fashion, but should avoid repetitive arm movements and heavy lifting for at least 3 months. You should also avoid placing the incision under direct pressure.

You will be given more detailed instructions about incision care before your surgery.

Are there any risks?
Like any type of surgery there is always a chance of developing a complication. These risks are low in ulnar nerve surgery.

The most common complications are wound infection (treated with antibiotics) and haematoma (blood clot).

There is a very small risk (less than 1 in 100) of damage to the nerve, which may cause permanent weakness and/or numbness. Another postoperative problem that sometimes occurs is wound hypertrophy, or thickening. In most cases the tenderness associated with the wound settles down over several months and does not cause any long-term problems.

What are the results of surgery?
Ulnar nerve decompression is successful in the majority of patients, and complications occur in a very small minority.