Ulnar nerve transposition is a surgery to move a nerve at the elbow. A new path will be made for the nerve to sit in.
Reasons for Procedure
The ulnar nerve runs by the inside of the elbow. The area can put pressure on this nerve and cause a range of symptoms. This is called cubital tunnel syndrome (CTS). It can lead to tingling and weakness in the arm.
This surgery will relieve the pressure on the nerve. It should help to relieve symptoms. If the nerve was badly injured or damaged, some symptoms may remain.
|Pressure on the ulnar nerve can cause problems in the pinky and ring fingers of the hand.|
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Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Excess bleeding
- Adverse reaction to anesthesia
- Blood clots
- Soreness in throat
- Nausea and vomiting
- Nerve injury
- Symptoms do not resolve with surgery
Before your procedure, talk to your doctor about ways to decrease your risk of complications. Factors that may increase your risk include:
What to Expect
Prior to Procedure
Your doctor will use previous tests to prepare for surgery. You may also need:
- A physical exam and review your medical history
- Order blood tests
Leading up to your procedure:
- Some medicine may cause complications during the procedure or recovery. They may need to be stopped up to 1 week before the procedure. Talk to your doctor before the procedure about all medicine you are taking.
- Do not start any new medicine, herbs, or supplements without talking to your doctor.
- Be sure that you have a ride to and from the hospital the day of your surgery.
- The night before, eat a light meal. Do not eat or drink anything after midnight unless told otherwise by your doctor.
Arrange for help at home as you recover.
This procedure may be done using:
- General anesthesia—you will be asleep
- Local anesthetic—the area being operated on will be numbed
Description of the Procedure
A cut will be made near the inside elbow. The ulnar nerve will be located. It will be moved from behind the elbow to the front. The nerve will be seated in 1 of the following:
- Under the skin and fat but above the muscle
- Within the muscle
- Under the muscle
The doctor will discuss the options with you before the surgery.
How Long Will It Take?
About an hour
Will It Hurt?
Anesthesia will prevent pain during the procedure. The incision will be uncomfortable after the surgery. The changes to the nerve may also cause some symptoms during recovery. Pain medicine will be given to help manage any discomfort.
At the Care Center
You will be monitored in a recovery area until you are ready to go home. Right after the procedure, the staff may:
- Elevate your arm using pillows.
- Apply ice to the area to reduce swelling.
- Apply a splint, bandages, and dressing to support the area.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
- Washing your hands often and reminding visitors and care team to do the same
- Reminding your care team to wear gloves or masks
- Not allowing others to touch your incisions
It will take a few weeks for the area to fully heal. Physical activity will need to be limited during recovery:
- Avoid heavy lifting or other strenuous activity until your doctor says it is okay.
- Be sure to follow your doctor’s instructions.
Your doctor may refer you to a physical therapist. Exercises will help restore strength and range of motion.
Call Your Doctor
Call your doctor if any of these occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Discoloration of the fingers of the affected hand
- Tingling and numbness of the affected hand
- Pain that you can't control with the medications you've been given
- New or worsening symptoms
If you have an emergency, call for medical help right away.
The National Institute for Occupational Safety and Health http://www.cdc.gov/niosh
Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.org
Canadian Centre for Occupational Health and Safety http://www.ccohs.ca
Canadian Orthopaedic Foundation http://www.canorth.org
Cubital tunnel syndrome. American Society for Surgery of the Hand website. Available at: http://www.assh.org/handcare/hand-arm-conditions/cubital-tunnel. Accessed June 2, 2018.
Jaddue D, Saloo S, et al. Subcutaneous vs. submuscular ulnar nerve transposition in moderate cubital tunnel syndrome. Open Orthop J. 2009;3:78-82. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738827. Accessed June 2, 2018.
Soltani AM, Best MJ, Francis CS, Allan BJ, Panthaki ZJ. Trends in the surgical treatment of cubital tunnel syndrome: an analysis of the National Survey of Ambulatory Database. J Hand Surg. 2013;36(8):1551-1556.
Ulnar nerve entrapment at the elbow (cubital tunnel syndrome). OrthoInfo—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00069. Updated September 2015. Accessed June 2, 2018.
Ulnar nerve entrapment of elbow. EBSCO DynaMed website. Available at: https://www.dynamed.com/topics/dmp~AN~T115940/Ulnar-nerve-entrapment-of-elbow . Updated June 18, 2018. Accessed June 2, 2018.
- Reviewer: Laura Lei-Rivera, PT, DPT, GCS
- Review Date: 06/2018
- Update Date: 06/02/2018