What are the other Names for the Procedure?
- Cubital Tunnel Syndrome Surgery
- Surgery for Cubital Tunnel Syndrome
- Ulnar Nerve Release
What is the Ulnar Nerve Decompression surgical procedure?
- Ulnar Nerve Decompression procedure involves relieving pressure on the ulnar nerve in the elbow by cutting a band of tissue, moving the nerve, or by removing a portion of bone in the elbow to create more space
- This helps to alleviate pain and other functional symptoms of cubital tunnel syndrome
What part of the Body does the Procedure involve?
Ulnar Nerve Decompression procedure involves the tissues within the elbow of the affected arm.
Why is the Ulnar Nerve Decompression surgical procedure Performed?
Ulnar Nerve Decompression is performed for the following reason:
- Cubital tunnel syndrome that does not respond to conservative treatment with pain medication, exercise, steroids, and splints
The cubital tunnel syndrome is characterized by pain, numbness or tingling in the elbow/hand/wrist/fingers due to a compression of the ulnar nerve that runs through a tunnel formed by tissue in the region of the elbow.
What are some Alternative Choices for the Procedure?
Splinting, exercises, and corticosteroid injections may be used to relieve symptoms. Usually, there are no alternatives to Ulnar Nerve Decompression surgery once conservative treatments measures have failed.
What are the Recent Advances in the Procedure?
There are no recent advances in the procedure.
What is the Cost of performing the Ulnar Nerve Decompression surgical procedure?
The cost of Ulnar Nerve Decompression procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding a Ulnar Nerve Decompression procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
http://neurosurgery.med.nyu.edu/conditions-we-treat/z-conditions-guide/ulnar-nerve-compression-elbow (accessed on 05/13/2015)
http://www.urmc.rochester.edu/neurosurgery/for-patients/treatments/ulnar-nerve-decompression.aspx (accessed on 05/13/2015)
http://orthoinfo.aaos.org/topic.cfm?topic=a00069 (accessed on 05/13/2015)
Prior to Ulnar Nerve Decompression surgical procedure:
How is the Ulnar Nerve Decompression surgical procedure Performed?
The Ulnar Nerve Decompression procedure may usually be performed under local anesthesia with or without sedation. Rarely, general anesthesia may be used if the muscles have to be cut in order to move the nerve.
There are multiple methods of releasing the compression on the nerve. The surgeon chooses the best method in any given circumstance. The surgeon makes an incision on the elbow of the affected arm.
- Simple decompression: The fibrous tissues overlying the ulnar nerve may be cut to create more space
- Simple decompression with epicondylectomy: Apart from the fibrous tissue, a portion of bone may also be removed
- Subcutaneous transposition: After freeing the nerve from compression, the ulnar nerve is moved into a position under the skin
- Submuscular transposition: This may be done under general anesthesia and the surgeon moves the ulnar nerve under the muscles near the elbow, by cutting them and re-suturing them after placing the nerve underneath
The skin incision is sutured after completion of the procedure.
Where is the Procedure Performed?
An Ulnar Nerve Decompression is usually performed in a hospital as an outpatient procedure.
Who Performs the Procedure?
The procedure is performed by any of these medical personnel, with or without assistance from an anesthesiologist:
- A neurosurgeon
- An orthopedic surgeon
How long will the Procedure take?
The procedure may be completed in less than an hour’s time.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Ulnar Nerve Decompression procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Ulnar Nerve Decompression surgical procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Ulnar Nerve Decompression surgical procedure?
Before an Ulnar Nerve Decompression, the patient has to undergo certain tests such as:
- Routine blood and urine analysis
- Other tests as directed by the healthcare provider
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is an Ulnar Nerve Decompression surgical procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
- What are the costs involved?
During the Ulnar Nerve Decompression surgical procedure:
What kind of Anesthesia is given, during the Procedure?
Local anesthesia by injection and sedation by injection is administered for this procedure
How much Blood will you lose, during the Procedure?
The blood loss during an uncomplicated Ulnar Nerve Decompression procedure is not significant.
What are the possible Risks and Complications during the Ulnar Nerve Decompression surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Ulnar Nerve Decompression surgery are:
- Infection within the surgical wound
- Accidental injury to the nerve
What Post-Operative Care is needed at the Healthcare Facility after the Ulnar Nerve Decompression surgical procedure?
Usually, no specific post-operative care is required after the Ulnar Nerve Decompression procedure. Patients are usually discharged from the hospital the same day as the procedure, or after an overnight stay.
After the Ulnar Nerve Decompression surgical procedure:
What are the possible Risks and Complications after the Ulnar Nerve Decompression surgical procedure?
The possible risks and complications that may arise after an Ulnar Nerve Decompression procedure are:
- Infection within surgical wound
- Persistent symptoms
What is the Prognosis after the Surgery?
The prognosis after an Ulnar Nerve Decompression procedure is good. The surgery helps in symptom relief in a vast majority of individuals.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Worsening pain and swelling around the surgical wound
- Bleeding or fluid drainage from the surgical wound
- The occurrence of any symptom that causes uneasiness such as nausea, vomiting, abdominal swelling, or constipation
- Signs of an infection
- Headache, muscle aches
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Ulnar Nerve Decompression surgical procedure?
At home, the following post-operative care is recommended after an Ulnar Nerve Decompression procedure:
- Slowly resume regular/daily activities as early as possible, which aids in faster recovery
- It may be necessary to wear a splint
- Physical therapy should be done as advised
- Use a heat pad or warm compress to relieve pain due to the incision
- Showering may be resumed after surgery, provided the wound is kept bandaged, clean, and dry. Avoid taking baths until the surgical wound is completely healed
- Avoid lifting of heavy weights
- Avoid driving for a few days after the procedure
- Complete the course of prescribed medication under advice of the physician
- Take antibiotic medication to help combat or prevent infection, per your physician’s advice
- Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)
How long does it normally take to fully recover, from the Procedure?
A complete recovery from the Ulnar Nerve Decompression procedure may take about 6-8 weeks.
What happens to tissue (if any), taken out during the Procedure?
Any tissue that is removed is disposed as per standard medical procedures.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
Usually, a pathologist does not get involved in the care of the patient.
Who will you receive a Bill from, after the Ulnar Nerve Decompression surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- A hospital
- An anesthesiologist (if anesthesia was administered)
- An orthopedic surgeon/ neurosurgeon
- The patient is advised to inquire and confirm the type of billing, before the Ulnar Nerve Decompression procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA