What does the operation involve?
An ulnar nerve release is an operation to treat cubital tunnel syndrome. It is also known as a cubital tunnel decompression. It can be performed under a general anaesthetic as a daycase procedure, with most people going home within hours of their surgery. Mr. Davies is also trained in performing this operation under local anaesthetic which some people prefer.
The procedure is performed through a 3-4cm cut over the inside of the elbow. Through this incision, Mr. Davies carefully opens the tunnel that the ulnar nerve runs in to relieve the pressure on the nerve. He then carefully checks other areas where the nerve can become trapped and releases the pressure in order areas if necessary. The skin is usually stitched using absorbable stitches that don’t need to be removed. A light dressing and bandage are applied.
Occasionally, the nerve is found to be more mobile than normal and it can move around the point of bone on the inside of the elbow. If that is the case, it is better to fix the nerve in a position in the front of the elbow to prevent it from becoming damaged. This operation is called an ulnar nerve transposition and involves stitching some tissue loosely around the nerve to keep it in place.
What are the specific risks and benefits of this operation?
The main benefit of this surgery is to relieve the pins and needles in your fingers caused by the nerve being compressed. As with any surgery, there are risks as well as benefits. The most frequent risks are:
- Infection: Around 1 in 100 people develop an infection in the skin where the cut was made. Infections will cause redness, increasing pain and sometimes some wound leakage around 1-2 weeks after surgery. It is important that you see your doctor if you think that this has happened. If you do have an infection, it usually settles with a course of antibiotics taken by mouth, but occasionally you may need surgery to wash the infection out of the wound.
- Problems with the scar: Some people develop a scar which is sensitive to touch or raised above the surrounding skin. Most scars take 3-6 months to settle and usually this problem gets better if you regularly massage your healed scar with moisturiser.
- Ongoing pins and needles, numbness or weakness: Most people report that the intermittent pins and needles gets better within weeks of this surgery. If you have permanent loss of sensation before surgery that does not come and go, or muscle weaknes in your hand, the result is less predictable. Recovery can take months and may be incomplete. People with more severe nerve compression are at the greatest risk of an incomplete recovery.
- Nerve injury: Mr. Davies takes great care to protect the nerve while operating very close to it. Rarely, the nerve can be damaged as part of this operation, resulting in weakness of your hand muscles and permanent loss of sensation.
- Risks of Anaesthetic: Before your operation, you will have your preop health checkup. Serious problems related to the anaesthetic are very rare (less than 1 in 10,000 for healthy people), but can be serious and sometimes life-threatening. These problems may include heart attack or a stroke, which can affect the movement of any part of your body, speech problems or even blindness. With any surgery, there is also a risk of a blood clot in your leg (DVT / deep vein thrombosis) or lung (PE / pulmonary embolism) and some people are given blood-thinning medications if their risk is higher. Your anaesthetist and surgeon can discuss your own personal risks and the measures they take to keep you as safe as possible throughout surgery.
What is the recovery after this surgery?
After the operation, you will have a bulky dressing on your elbow. This should be left in place for 1 weeks, after which you may unwind it yourself. There are usually no stitches to remove. You will receive instructions from the physiotherapist about moving your elbow. It is most important that you do not over-protect your elbow and start moving it gently right away to prevent stiffness. There is no need to wear a sling. Most people have little or no pain immediately after surgery due to the local anaesthetic put into the wound. It is vitally important that you start taking painkillers supplied to you before the local anaesthetic wears off. Some people also find an ice pack helpful in the first few days. It is advisable to get on your feet and walk around frequently to reduce the risk of blood clots in your legs.
You will usually be seen in clinic 2-4 weeks after surgery to check that everything is OK.
Returning to Normal Activities
You can do light activities as you feel comfortable. It is advisable to avoid heavy lifting and repetitive work for 6 weeks after surgery to allow your tissues to heal.
When can I drive?
Most people can return to driving after around 1-2 weeks or when they feel comfortable.
When can I return to work?
This depends on how heavy your work is. If you work at a desk, this can be as soon as you feel comfortable. For heavier jobs, it will take longer. The key is to listen to your body, don’t overdo it, and build up to normal activities slowly.
When can I return to sport?
Some sports put more strain on your elbow than others. Most people return to light exercise in 2-4 weeks and can then slowly build up to normal activity from there. The key is to listen to your body, don’t overdo it, and build up to normal activities slowly.