Ulna Nerve Transposition

The tingling in the outside of your hand is getting worse and the NCS tests have proved that it is because the nerve is being compressed at the elbow. The way to deal with that is by surgery.

So what happens?

The operation is done as a day-case and under a general anaesthetic. Yes – you do need a general aneasthetic. I am operating on a nerve and it would not be good if you were to start twitching and moving around at the wrong moment. So off to sleep you go!

Where is the scar and how big will it be?

The scar is on the inside of the elbow and runs along the course of the nerve for 6 – 8 cms. You can usually feel the nerve yourself in its groove between the bony lump on the inside of the elbow and the bony point of the elbow. The scar will be in a pretty hidden position so really won’t be easy to see.

How do you unsqueeze the nerve?

The nerve runs in a groove between those two bony prominences but just before it turns the corner and just after, it is held in place by tunnels or arches of fibrous tissue. And this is usually where it gets squeezed.

So what I do is release the nerve from where it normally runs and make those tunnels bigger so there is no squeeze on it any more. But if I just left it in the same place you could get problems again because remember, one of the issues is the nerve getting tight when the elbow is bent.

The next step therefore is to move the nerve (transpose it) so it can take a shortened route around the elbow. That means when you bend the elbow the nerve doesn’t get stretched. So I gently move it in front of the bony lump and create a little sling of tissue to hold it there.

Any stitches? Do I need a sling?

The stitches are dissolvable ones under the skin so you don’t need to worry about those.

You do need a sling for about a week. This is just to allow everything to calm down and start to heal. You can turn the hand and wrist round and move the elbow up and down a little bit (maybe 30 degrees or so) to try and stop it stiffening up too much. There is a padded bandage around the elbow that you take off after 4 days and there will be a waterproof dressing over the scar so you can then shower and bath.

After a week you can get rid of the sling and start using the arm as normal.

Will the tingling go straight away?

In many people it does but the nerve has a memory so, even when the squeeze is taken off it, it can still think it is being compressed for up to 6 weeks. Sometimes longer if the symptoms have been very severe or you have had them for a long time.

So when can I drive?

As soon as you are out of the sling (a week!) AND confident that you have enough movement and function in the elbow you to control a car.

And using the arm for work and sports?

Pretty quickly. You could probably use a keyboard even while in the sling so that, if your job allows it, you could work from home or even from your desk if you really had to go straight back.

For a more physical job, and for most sports, you should be pretty good after 2 weeks and fine after 4.

Does it always work?

No, it does not have a 100% success rate. The two main problems are that your body can over-react and produce a lot of scar tissue around the nerve and, from time to time, I have had to go back and re-release the nerve. And sometimes the compression has just been too much or gone on for too long and the nerve has been permanently damaged.