ulnar nerve repositioning surgery recovery

I am about to have ulnar nerve repositioning surgery and am concerned about the time of rehabilitation to my arm. I have also read that alot of people have had to have re-do surgeries in about 2 years. I just need to know what I am facing as far as recovery from the surgery goes.

Thanks,
Joye Cook

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

I would be happy to provide you with whatever information I can regarding ulnar nerve injury repositioning surgery but I think you might be provided with useful information on a neurosurgical forum as well.

This surgery is indicated in cases in which progressive weakness of the muscles supplied by the ulnar nerve occurs. Injury may occur either due to trauma or entrapment of the nerve (most commonly either at the elbow or the wrist).

After an injury to the bones of the wrist, while the wrist is in cast, if progression of muscle weakness occurs, surgery should not be jumped to right away in some cases. Rather, some time should be given for the swelling to go down, because once it has, symptoms may improve on their own.

The procedure should not be used in cases of severe neuropathy due to trauma in cases in which there is scarring, sublaxation (sliding of the nerve to a significantly different position), or dislocation of the nerve from the area where it resides in the elbow groove. A transposition may not relieve the nerve through its entire course, and this may lead to redo operations. The surgical technique depends on not only the mechanism and type of ulnar nerve injury but also the patient's habitus and lifestyle. There are a few types of transposition procedures (subcutaneous, meaning under the skin, and intramuscular, meaning within the muscle). Intramuscular transposition has a higher complication rate because of a lot of scarring that may occur.

With the procedure decompression in situ a balance has to be struck between how much tissue is removed versus left in. When the nerve is being decompressed by removal of surrounding ligaments or other tissues, removing too much tissue may relieve the nerve but cause instability around a joint (such as the elbow). Removal of too little will not relieve the compression well. Different procedures are available depending on where the compression is occuring (for example at the wrist vs at the elbow). Each procedure obviously has its advantages, disadvantages, and failure rates. For some procedures, immobilization of the limb is necessary afterwards, for others it is not.

Potential complications of the surgery include (depending on the type of surgery chosen) injury to the nerve, scarring in the area, failure of decompression, creation of a new area of entrapment, infection, failure to heal, clotting of veins, and others.

When the ulnar nerve problem has been going on for several months, the success rate of surgery is less.

Physical therapy is important after the surgery. Some patients don't feel their arm/hand is entirely back to normal for 3-6 months, but some patients have faster results (it depends on the extent of the initial injury and the type of surgery).

I hope you find this information useful, thank you for the opportunity to answer your questions, good luck.

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