A compression of the ulnar nerve (or cubital nerve syndrome) is a pathology of the upper limbs which leads to a decrease in sensitivity, paresthesia and a decrease in the strength of the hand. A decompression of the ulnar nerve is an elbow surgery that can treat this neurological pathology by protecting the ulnar nerve and lifting points of compression responsible for pain and sensitivity disorders.
What is a decompression of the ulnar nerve?
What is the ulnar nerve?
The ulnar nerve (or ulnar nerve) is one of the sensitivo-motor nerves of the hand fulfilling a double function:
- a motor function by allowing the action of the flexor muscles and the interosseous muscles of the hand
- a sensory function by allowing to feel the sensation touching the ear and ring fingers (4th and 5th fingers).
What is a compression of the ulnar nerve?
A compression of the ulnar nerve is a pathology of the elbow and hand in which the nerve is "stuck" along its path, usually at the elbow. The ulnar nerve is extremely vulnerable to the osteofibrous canal of the elbow. It is the most common neurological pathology in humans after carpal tunnel syndrome.
Symptoms of cubital tunnel syndrome
There are several symptoms of cubital tunnel syndromes:
- Paresthesias in the hands (numbness, "ants")
- Loss of sensitivity in the little finger, ring finger and on the edge internal hand
- Difficulty shaking hands or performing daily actions (use scissors, for example)
- Muscle fusion of the first interosseous space
- Pain in the hand, sometimes along the forearm.
The onset of symptoms can be done gradually (summation of microtrauma) or as a result of unusual movements of the arm.
An electromyogram is usually performed to confirm the diagnosis and locate the seat of ulnar nerve compression. This is a technique consisting of measuring the speed of circulation of nerve impulses.
Principle of a surgical decompression of the ulnar nerve
A decompression of the ulnar nerve is a surgical intervention whose objective is to protect the ulnar nerve by raising the point (s) of compression.
In case of early compression or little symptomatic (appearance of paresthesia only), functional treatment with rehabilitation, infiltration and wearing a detachable nocturnal brace at the elbow may be considered. If the symptoms are more important or if the functional treatment fails to correct them, surgical decompression is necessary.
A surgery that must be performed as soon as possible
It should be known that the earlier the surgical treatment (as soon as the first symptoms appear), the more effective the postoperative result.
The procedure is usually performed on an outpatient basis under general anesthesia or under loco-regional anesthesia of the upper limb (only the arm is asleep).
The procedure is to open the arch in which the ulnar nerve passes. This action may be sufficient to decompress the nerve if it sits there and if the nerve is stable in the gutter during flexion of the arm.
Additional interventions in specific cases
If the nerve is unstable in the gutter or if the compression zone does not appear obvious, it is necessary to perform an additional surgical procedure.
- Either an epitrochleectomy, which is to reduce the thickness of the bony protrusion of the elbow (called "epitrochlée").
- Either take the ulnar nerve out of the gutter and pass it in front of the epitrochlea.
- Either an elongation of the muscular arch responsible for the compression, in order to limit the risk of recurrence.
Recovery after an ulnar nerve decompression surgery
The operative follow-up of ulnar nerve decompression is simple in the vast majority of cases.
The bruise that appears at the end of the procedure disappears gradually (complete disappearance in 15 days on average).
The disappearance of symptoms and functional recovery depend on the precocity of the intervention. In the case of simple compressions, quickly diagnosed and treated, sensory disorders and pain disappear quickly (within a few days). In cases of severe compression, the disappearance of paresthesia is slower and recovery may take several months. In the case of old or very large compression, recovery may not be complete.
Rehabilitation can be indicated if necessary.
The support on the inner edge of the elbow (where the scar is present) can remain painful for a few months.
The risk of recurrence is rare (less than 10% of cases).
Smoking increases the risk of surgical complications of any surgery. Stopping smoking 6-8 weeks before the procedure eliminates this additional risk. If you smoke, talk to your doctor, surgeon, and anesthesiologist, or call Tobacco-Info-Service at 3989 to help reduce risk and put the odds on your side.