What is ulnar neuropathy (tardy ulnar palsy)?
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.

Who will perform surgery? Who else will be involved?
Surgery will be carried out by your Precision Neurosurgery surgeon. A surgical assistant will be present and an experienced anaesthetist will be responsible for your anaesthetic. Ulnar nerve decompression is usually performed under a light general aneasthetic.

What are the aims and potential benefits of surgery?
The goals and potential benefits of surgery include:

• Relief of neural compression
• Pain reduction
• Prevention of further deterioration

The chance of obtaining a significant benefit from surgery depends upon a wide variety of factors. Your neurosurgeon will give you an indication of the likelihood of success in your specific case.

What are the possible outcomes if treatment is not undertaken?
The natural history (ie the outcome if carpal tunnel syndrome is left untreated) is difficult to predict. Potential outcomes of not treating your condition include:

• Ongoing pain
• Paralysis/weakness/numbness
• Impaired hand function

What do you need to tell your doctor before surgery?
It is important that you tell your surgeon if you:

• Have blood clotting or bleeding problems
• Have ever had blood clots in your legs (DVT or deep venous thrombosis) or lungs (pulmonary emboli)
• Are taking aspirin, warfarin, or anything else (even some herbal supplements) that might thin your blood
• Have high blood pressure
• Have any allergies
• Have any other health problems

How is the surgery performed?
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 are the specific risks of this surgery?
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 risks of anaesthesia and the general risks of surgery?

• Significant scarring (‘keloid’)
• Wound breakdown
• Drug allergies
• DVT (‘economy class syndrome’)
• Pulmonary embolism (blood clot in lungs)
• Chest and urinary tract infections
• Pressure injuries to nerves in arms and legs
• Eye or teeth injuries
• Myocardial infarction (‘heart attack’)
• Stroke
• Loss of life
• Other rare complications

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.

What should you notify your doctor of after surgery?

• Fever
• Swelling, redness, increased temperature, or possible infection of the wound
• Weakness or numbness of the hand or fingers
• Hand swelling, temperature changes, or discolouration
• Any other concerns

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

What are the costs of surgery?
Private patients undergoing surgery will generally have some out-of-pocket expenses.

A quotation for surgery will be issued, however this is an estimate only. The final amount charged may vary with the eventual procedure undertaken, operative findings, technical issues etc. Patients are advised to consult with their Private Health Insurance provider and Medicare to determine the extent of out-of-pocket expenses.

Separate accounts will be rendered by the anaesthetist and sometimes the assistant, and hospital bed excess charges may apply. Medical expenses may be tax deductible (you should ask your accountant).

You should fully understand the costs involved with surgery before going ahead, and should discuss any queries with your surgeon.

What is the consent process?
You will be asked to sign a consent form before surgery. This form confirms that you understand all of the treatment options, as well as the risks and potential benefits of surgery. If you are unsure, you should ask for further information and only sign the form when you are completely satisfied.