Ulnar nerve transposition surgery alleviates pressure on the ulnar nerve, often treating cubital tunnel syndrome. This condition occurs when the ulnar nerve, located inside the elbow, becomes compressed. During surgery, the nerve is moved from behind the medial epicondyle (the bony bump on the inside of the elbow) to a new location, typically in front. This article discusses common post-surgery issues.
Immediate Post-Surgery Experiences
Patients commonly experience expected sensations as the body heals. Pain is normal, especially as local anesthetic or nerve block wears off (typically 6-24 hours post-operation). Swelling and bruising around the elbow and forearm are also common, resulting from tissue manipulation.
Temporary numbness or tingling in the small and ring fingers is common due to ulnar nerve manipulation. This sensation can persist for days to weeks, often improving quickly. Initial limitations in arm and hand movement are anticipated, often managed with a splint or sling to immobilize the elbow for two to four weeks to facilitate healing. A low-grade fever may also occur within the first one to two days, often related to anesthesia response and manageable with deep breathing exercises.
Potential Complications
While ulnar nerve transposition surgery generally has a favorable success rate, complications can arise. Infection at the surgical site is a risk, presenting as worsening redness, warmth, pus drainage, or a fever above 101-102 degrees Fahrenheit. Maintaining a clean and dry incision site minimizes this risk.
Another potential issue is the formation of a hematoma (blood collection) or seroma (fluid collection) under the skin at the surgical site. Hematomas have been reported in about 15% of transposition cases, with some requiring drainage.
Nerve injury is a concern, though significant direct damage to the ulnar nerve or its main branches is rare with an experienced surgeon. However, a small branch supplying skin near the incision can be affected, leading to a permanent patch of numbness.
Recurrence of nerve compression can occur if the nerve shifts back or if new scar tissue forms around the nerve in its transposed location. This scarring can create a tether point, leading to renewed symptoms. In some instances, surgery may fail to alleviate original symptoms, particularly if nerve damage was severe pre-surgery.
Persistent Symptoms and Recovery Hurdles
Beyond the immediate post-operative phase, some individuals may experience persistent symptoms or challenges during recovery. Residual numbness, tingling, or weakness in the affected fingers and hand can continue for several months, with slow improvement. If the nerve was severely damaged pre-surgery, complete return of normal sensation or strength may not occur, though surgery can prevent further worsening.
Stiffness or limited range of motion in the elbow or hand is another common hurdle, mitigated by early mobilization of unaffected joints and adherence to physical therapy. Scar tissue sensitivity or pain at the incision site can also persist for several months, sometimes improving with massage.
Challenges with physical therapy exercises or regaining full strength and dexterity can prolong recovery, as rehabilitation is a gradual process. Neuropathic pain (nerve-related pain) can develop or persist, sometimes radiating from the elbow into the hand. This type of pain can be complex to manage and may require additional interventions.
When to Contact Your Doctor
Knowing when to seek medical attention after ulnar nerve transposition surgery is important. Immediate contact with your doctor is warranted if you observe signs of infection, such as increasing redness, warmth, significant swelling, pus draining from the incision, or a fever above 101.5 degrees Fahrenheit.
A sudden, severe increase in pain not alleviated by prescribed medication also requires prompt evaluation. New or worsening numbness, weakness, or inability to move your fingers or hand should be reported without delay.
Excessive swelling or continuous bleeding from the incision site beyond a small amount of drainage is also a cause for concern. Any sudden or unexpected change in your symptoms, such as a pale or cool hand or a cast/splint that feels too tight, warrants contacting your medical provider or seeking emergency care.