Ulnar Nerve Transposition (Cubital Tunnel Surgery)

Overview

Ulnar nerve transposition is a surgical procedure to relieve compression of the ulnar nerve at the elbow (cubital tunnel syndrome). The surgery involves moving the ulnar nerve from its position behind the medial epicondyle to a new location in front of the elbow, which reduces tension and compression on the nerve. Alternative procedures include simple decompression or medial epicondylectomy.

Indications

This procedure may be considered when:

• •Cubital tunnel syndrome not improved by conservative treatment
• •Persistent numbness, tingling, or weakness in the ulnar nerve distribution
• •Progressive muscle weakness or atrophy in the hand (intrinsic muscles)
• •Electromyography (EMG) or nerve conduction studies confirming ulnar neuropathy
• •Symptoms significantly affecting hand function or daily activities
• •Failure of splinting, activity modification, and other conservative measures

How It Works

The procedure typically involves several coordinated steps:

• •The procedure is performed under regional or general anesthesia
• •An incision is made along the inner aspect of the elbow
• •The ulnar nerve is identified behind the medial epicondyle
• •The nerve is carefully freed from surrounding tissues
• •Sources of compression (Osborne ligament, muscle, bone spurs) are released
• •Anterior transposition: The nerve is moved to the front of the elbow
• •The nerve may be placed subcutaneously, intramuscularly, or submuscularly
• •Simple decompression (in situ release) leaves the nerve in place but releases constrictors
• •The wound is closed and a dressing or splint is applied

Risks

As with any surgical procedure, potential risks include:

• •Persistent or recurrent symptoms
• •Nerve injury during surgery
• •New areas of nerve compression after transposition
• •Elbow pain or instability (rare)
• •Medial epicondyle tenderness
• •Infection
• •Hematoma or seroma
• •Wound healing problems
• •Need for additional surgery

Recovery Expectations

Recovery follows a gradual progression:

• •The procedure is typically performed as outpatient surgery
• •A splint may be worn for 1 to 3 weeks depending on the technique used
• •Early finger and wrist motion is usually encouraged
• •Elbow motion is gradually restored over several weeks
• •Physical or occupational therapy may focus on nerve gliding and strengthening
• •Numbness and tingling may improve gradually over weeks to months
• •Muscle strength may continue to improve for 6 to 12 months or longer
• •Full recovery of nerve function depends on the degree of preoperative damage

Alternatives

Depending on individual circumstances, alternatives may include:

• •Continued conservative treatment with splinting and activity modification
• •Nighttime elbow splinting in extension
• •Elbow pad to protect the nerve from direct pressure
• •NSAIDs for associated inflammation
• •Physical or occupational therapy for nerve gliding exercises
• •Simple in situ decompression without transposition
• •Medial epicondylectomy (removing part of the bony prominence)

Sources

• Cleveland Clinic – Cubital Tunnel Syndrome