How Do You Release a Trapped Ulnar Nerve?

Ulnar nerve release is a surgical procedure that helps release the compression on the ulnar nerve and the symptoms caused by the compression of the ulnar nerve. Inflammatory conditions such as rheumatoid arthritis and osteoarthritis, and cubital tunnel syndrome are common conditions it treats.

The ulnar nerve is one of the three main nerves in the arm that travel from the neck through a bony protuberance (medial epicondyle) in the elbow, under the muscles of the forearm, down the hand, the side of the palm up to the pinky finger. The ulnar nerve controls most of the hand muscles that carry out fine movements and some bigger forearm muscles that help in making a strong grip.

The ulnar nerve can be constricted at many places, which results in nerve entrapment. The compression pressure on the nerve can cause pain and numbness in various parts of the arm. The compression of the nerve occurs most commonly against the medial epicondyle and is called cubital tunnel syndrome. 

Ulnar nerve release is a surgical procedure performed to release the compression on the ulnar nerve and the symptoms caused by the compression of the ulnar nerve. 

An ulnar nerve release surgery is indicated in patients in the following conditions:

• The most common indication of ulnar nerve release is cubital tunnel syndrome.
• Compression of the ulnar nerve caused following trauma or excessive pressure on the elbow
• Ulnar nerve entrapment due to inflammatory conditions such as osteoarthritis or rheumatoid arthritis
• Failure of conservative therapy measures
• Functional loss in the hands or fingers

Contraindications for an ulnar nerve release surgery include the following:

• Deformity or instability of the elbow
• Tumors and cysts
• Changes to the joint due to arthritis 

Relative contraindications include recurrent problems of the nerve.

Before the surgery

• Prior to the surgery, the doctor will perform a clinical examination, advise blood tests and perform radiological assessment (X-ray, computed tomography [CT], and magnetic resonance imaging [MRI]).

During the surgery

• The procedure is performed using anesthesia.
• There are various surgical techniques and approaches. The choice of approach depends on the site of compression, extent of disease, and surgeon’s discretion. Typically, an incision is made behind the elbow joint. The ulnar nerve is identified, and the course of the nerve is traced. Any soft tissue or bone that is compressing and irritating the nerve is released. Finally, the nerve is left in the groove.
• The procedure can also be performed endoscopically. Endoscopic ulnar nerve release is a less invasive procedure, and the healing is faster. A small incision is made behind the medial epicondyle, through which a scope (a camera with a light source) and surgical instruments are inserted. 

After the surgery

• Painkillers and antibiotics would be prescribed after the surgery. The patient is advised to keep the wound dry, gently compressed and elevated after the surgery. Early mobilization of the arm is encouraged because it reduces stiffness. 
• The arm may be placed in a sling for a few days postoperatively. Rigorous exercise, heavy lifting, or repetitive tasks involving the arm should be avoided until the surgeon allows it. The surgeon and physiotherapist would recommend an exercise regimen to rehabilitate the arm. Simple analgesia should be taken as required.
• The patient is advised to visit the surgeon or an emergency room (ER) right away if there is any sign of infection (fever, new pain, swelling, warmth, redness, or pus from the operative site), loss of sensation or function.

Potential complications of an ulnar nerve release surgery are:

• Incomplete or inadequate decompression of the nerve and/or entrapment at a different location causing recurrence of symptoms
• Bleeding 
• Scar formation 
• Change in nerve position 
• Direct injury or stretching injury to the ulnar nerve 
• Loss of sensation or function 
• Local postoperative hematomas (blood clots) 
• Wound infection