Facing the possibility of ulnar nerve transposition surgery can bring many concerns about what lies ahead and doubts about proceeding with the operation. This article aims to answer the most common questions you might have, covering the procedure, what to expect before, during and after it, and what adjustments in your life you may need to make during recovery from the surgery and after it.
Why am I offered the surgery?
After a physical examination by a doctor and some tests, you then would be diagnosed with the condition and offered the most appropriate treatment.
Other treatments didn’t work
Non-invasive treatments are usually offered first. For example, fixation of your arm with a splint or physiotherapy as well as pain relief medication. These recommendations will be personalised based on all of the tests and your medical history and differ from patient to patient. If the non-invasive approach doesn’t help or your symptoms are getting worse very quickly, you will be offered the surgery. Moreover, if symptoms are severe, your doctor may offer you the surgery right away.
What exactly is this surgery? Is it really necessary?
During the surgery, the compressed nerve will be moved to get rid of the compression and thus pain and other symptoms. The ulnar nerve plays a key role in the movements and sensations in your hand, especially the ring and little finger.2 Because of where in the arm the ulnar nerve is located it can be relatively easily trapped (Figure 1-A). When trapped, the nerve gets compressed which leads to the main symptoms of the Ulnar Nerve Entrapment (Figure 1-B). There are a variety of potential treatments you may be offered if you were diagnosed with it before the surgery is offered, as was discussed above.
If you are in doubt about whether or not to proceed with the surgery, consult with the doctor to make an informed decision. Consider all potential risks and benefits of the surgery as well as the refusal of the surgery. Let’s look at a few of them.
Figure 1. Ulnar nerve location, entrapment, and transposition. A - location of the nerve in the arm, B - how the position of the nerve changes when entrapped, C - general illustration of the ulnar nerve transposition result.
What are the risks and benefits of the surgery?
Table 1 lists the main risks and benefits. Benefits include relief from pain, numbness, and tingling in your hand and fingers. It also prevents further damage to the ulnar nerve, potentially improving hand function and quality of life.3 The risks associated with the surgery are mostly linked to the recovery phase and include common surgical complications such as infection, bleeding, and possible nerve damage.4
However, these risks can be substantially minimised by following your doctor's post-operative advice, which may include guidelines on wound care, medication, and activity restrictions. Adhering closely to these recommendations plays a key role in ensuring a smooth and successful recovery process.
Table 1 Risks and benefits of the ulnar nerve transposition procedure.
What is happening during surgery?
In summary, the trapped nerve will be released from its trapped position and moved away from the bone structures inside the muscle tissue (Graph 1-C).5 That is done to prevent the recurrence of the entrapment. There are three main steps in the surgical procedure:
- Incision - when the doctor gets access to the nerve.
- Nerve transposition - the main part of the surgery, when the nerve is relocated into the muscle tissue to remove the pressure caused by entrapment.
- Closure and Dressing - during this part of the surgery, the incision is closed, and the wound is prepared for healing.
How long does the surgery typically take?
Usually, the surgery doesn’t take more than a few hours. However, the exact timeframe will depend on your medical history and other factors.
Will anaesthesia be used?
In most cases, this procedure will be done under general anaesthesia. However, depending on your medical history you may be offered a local one. The best choice will be identified by the doctor based on your personal medical history to minimise the chance of complications.
Will I have to stay in the hospital after the surgery?
You might need to at least for a short while to make sure there are no immediate post-surgical complications. It also may be important to establish the best follow-up plan and the best pain relief medication if needed.
After the surgery
How will I feel right after the surgery? Will I feel immediate relief?
Because this is an invasive procedure, you may experience pain or discomfort and swelling after the surgery. It’s normal and is the first step towards recovery.
How can I manage pain after the surgery?
To cope with the pain, your doctor will prescribe you appropriate pain relief medication.
Will I have a scar from the surgery?
Yes, scar formation is a normal part of the recovery. The size and appearance may differ, and your doctor may advise you on measures to minimise scarring.
Figure 2. Recovery timeline of the ulnar nerve transposition surgery.
Recovery timeline
The period of recovery after the surgery can be divided into 3 parts: short-term and long-term rehabilitation, then monitoring the recurrence.6
Short-term recovery
- Immediate (1-2 weeks)
This period is focused on wound care to prevent infection, rest and limiting the use of the arm the surgery was performed on.
- Early rehabilitation (2-4 weeks)
At this point, you may be offered to begin doing gentle exercises that the physiotherapist will offer to you. The pain management, general rest and wound care from the previous step would also continue.
Long-term recovery
- Return to activities (1-3 months)
As the arm heals, it will be possible to gradually start to return to everyday activities. It is important to note that the speed and intensity are very individual and should be discussed with your doctor.
- Ongoing rehabilitation (3-6 months)
This period of recovery will be mainly focused on physiotherapy to regain the strength and functionality of your arm and hand.
Monitoring recurrence (after 6 months)
Even with a 6-month recovery period, it's still important to watch out for any unusual changes in your arm. Even though formal recovery is over, the chance of recurrence is always there. Being aware of that and alerted can help to catch it early on.
If you notice any of the following signs: increased pain, swelling (whether it's sticking around or coming back), redness, or any oozing where you had surgery get in touch with a doctor right away. These could be signs that something's not right. Also, if you start having trouble feeling or moving your arm like you used to, your doctor should know about it as soon as possible.
How often will I need follow-up visits after surgery?
It varies from person to person, but in general, the doctor would like to see you in a few weeks and then as needed. It is important to consult with your doctor to make sure you are seen by your doctor in time.
Lifestyle adjustment and returning to normal life
As part of the recovery, you will be recommended to make certain lifestyle adjustments.7 It is important to follow a doctor’s advice to make sure your recovery is successful.
The main changes would include:
- Ergonomic changes at work:8
- Regular breaks
You may need to take breaks more often and for longer periods. Seek your doctor’s advice and consult with a physiotherapist for personalised recommendations. - Proper body position
To prevent recurrence or complications due to bad body positions. This would need to be reviewed and adjusted with the assistance of your doctor and your employer.
- Regular breaks
- Exercises:9
Your physiotherapist will probably recommend the best exercises to help you with the recovery. Nevertheless, if you feel any pain or discomfort while doing those, you should let them know as soon as possible because the chosen exercises may not be suitable for you. - Dietary changes:10
A healthy and balanced diet, enough proteins and healthy fats are essential for effective recovery. Additionally, vitamins A, B, C, Zinc and other supplements may be recommended. Always ask your doctor before you start to take any supplements because those might be unsuitable or even dangerous for you!
How soon can I return to work or other daily activities?
It varies heavily from person to person. Your doctor will advise you when it is safe to resume each of the activities you had to stop due to the injury and/or surgery. It’s important to remember that you shouldn’t push your body, because instead of speeding up the recovery it may cause a setback in it
Summary of ulnar nerve transposition surgery
Why surgery?
Ulnar nerve transposition is recommended if non-invasive treatments (like splinting or physiotherapy) fail to relieve symptoms or if your condition is severe. This surgery addresses ulnar nerve entrapment, which can cause pain, numbness, and weakness, particularly in the ring and little fingers.
Surgery overview
The procedure involves relocating the compressed ulnar nerve to relieve pressure and alleviate symptoms. The surgery typically includes making an incision, moving the nerve, and closing the incision. It usually lasts a few hours and is performed under general anaesthesia.
Post-surgery expectations
Post-operatively, you may experience pain, swelling, and discomfort. Pain management will be provided by your doctor. Scarring is normal, and its extent varies.
Recovery timeline
- Immediate (1-2 weeks): Focus on wound care and rest.
- Early Rehabilitation (2-4 weeks): Begin gentle exercises and continue pain management.
- Return to Activities (1-3 months): Gradually resume normal activities.
- Ongoing Rehabilitation (3-6 months): Focus on physiotherapy to regain strength and function.
- Monitoring (after 6 months): Watch for signs of recurrence such as pain or swelling and report any concerns to your doctor.
Lifestyle adjustments
- Work Ergonomics: Regular breaks and proper body positioning are crucial.
- Exercises: Follow physiotherapist recommendations and report any pain.
- Diet: Maintain a balanced diet with adequate proteins, healthy fats, and vitamins, consulting your doctor before taking supplements.
Returning to daily life
The resumption of work and activities varies by individual. Consult your doctor for personalized advice on when and how to return to your regular routines. Avoid rushing the recovery process to prevent setbacks.
References
- Vij N, Traube B, Bisht R, Singleton I, Cornett EM, Kaye AD, et al. An Update on Treatment Modalities for Ulnar Nerve Entrapment: A Literature Review. Anesth Pain Med. 2020;10(6):e112070
- Polatsch DB, Melone CP, Jr., Beldner S, Incorvaia A. Ulnar nerve anatomy. Hand Clin. 2007;23(3):283-9, v.
- Hearon BF, Frantz LM. Ulnar Nerve Anterior Transmuscular Transposition in the Lateral Decubitus Position. J Hand Surg Am. 2019;44(4):346.e1-.e7.
- Davis GA, Lal T, Hearps SJC. Risk factors and outcomes in 385 cases of ulnar nerve submuscular transposition. J Clin Neurosci. 2021;87:8-16.
- Mezian K, Jačisko J, Kaiser R, Machač S, Steyerová P, Sobotová K, et al. Ulnar Neuropathy at the Elbow: From Ultrasound Scanning to Treatment. Front Neurol. 2021;12:661441.
- Antoniadis G, Richter HP. Pain after surgery for ulnar neuropathy at the elbow: a continuing challenge. Neurosurgery. 1997;41(3):585-9; discussion 9-91.
- Weirich SD, Gelberman RH, Best SA, Abrahamsson SO, Furcolo DC, Lins RE. Rehabilitation after subcutaneous transposition of the ulnar nerve: immediate versus delayed mobilization. J Shoulder Elbow Surg. 1998;7(3):244-9.
- Stock SR. Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limbs: A meta‐analysis. American journal of industrial medicine. 1991;19(1):87-107.
- Erickson BJ, Chalmers PN, D’Angelo J, Ma K, Romeo AA. Performance and return to sport after ulnar nerve decompression/transposition among professional baseball players. The American Journal of Sports Medicine. 2019;47(5):1124-9.
- El Soury M, Fornasari BE, Carta G, Zen F, Haastert-Talini K, Ronchi G. The Role of Dietary Nutrients in Peripheral Nerve Regeneration. Int J Mol Sci. 2021;22(14).
