What is Ulnar Nerve Transposition

Ulnar nerve transposition is a surgery to move the ulnar nerve. The surgery is done to treat a condition in which the ulnar nerve gets squeezed (compressed) behind the elbow (cubital tunnel syndrome). You may need this surgery if other treatments for cubital tunnel syndrome have not worked.

The ulnar nerve starts in the neck, passes behind the elbow, and travels down to the hand. During an ulnar nerve transposition, your surgeon will move your ulnar nerve to the inside of the arm, so that the nerve passes in front of your elbow instead of behind your elbow.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Nerve damage, which can cause tingling, numbness, or weakness.
• Persistent pain after surgery.
• Bleeding.
• Infection.
• Damage to blood vessels.
• Allergic reactions to anesthetics.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Plan to have someone take you home after the procedure.
• If you go home right after the procedure, plan to have someone stay with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area above your elbow to numb everything beyond the injection site (regional anesthetic).
• After the anesthesia starts to work, your surgeon will make a surgical cut (incision) along the inside of your elbow.
• The muscles beneath the skin will be moved out of the way to reveal the ulnar nerve.
• The nerve will be lifted out of place and repositioned in front of your elbow. Your surgeon may place the nerve above or below the muscle layer.
• The incision will be closed with stitches (sutures), staples, or surgical glue.
• A bandage (dressing) will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will be given medicine to control pain.
• You may have to wear a sling to protect your arm and prevent it from moving while you heal.
• Do not drive for 24 hours if you received a sedative.

Care After Ulnar Nerve Transposition

These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Tenderness.
• Stiffness.
• Bruising.
• Swelling.

Follow these instructions at home:

If you have a sling:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the sling if your fingers become numb and tingle, or if they turn cold and blue.
• Do not let your sling get wet if it is not waterproof.
• Keep the sling clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• Keep the bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Change your dressing as told by your health care provider.
  • Wash your hands with soap and water before you change the dressing. If soap and water are not available, use hand sanitizer.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed, apply ice to your elbow area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times per day.
• Move your fingers often to avoid stiffness and to lessen swelling.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you received a medicine to help you relax (sedative) during your procedure.
• Ask your health care provider when it is safe to drive.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything with the affected arm until your health care provider says you can.
• Do exercises as told by your health care provider and physical therapist.

General instructions

• Do not use any tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You develop new tingling, numbness, or weakness in your arm or hand.
• You have pain that is not controlled by your pain medicine.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.

Get help right away if:

• You have severe pain.
• You lose feeling in your arm or hand.
• Your hand or fingers turn very pale or blue.