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. |
