• William F. Scully III MD
  • William F. Scully III MD
  • William F. Scully III MD

Ulnar Nerve Decompression at the Elbow

What is Ulnar Nerve Decompression?

Ulnar nerve decompression is a procedure to treat ulnar nerve entrapment. The ulnar nerve travels down the back of the elbow behind the bony bump called the medial epicondyle and through a narrow passageway on the inside of the elbow called the cubital tunnel. Entrapment or compression of the nerve in this region is also referred to as cubital tunnel syndrome

The cubital tunnel is formed by bone, muscle and ligaments with the ulnar nerve passing through its center. The roof of the cubital tunnel is covered with soft tissue called fascia. When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump. When the ulnar nerve is compressed or entrapped, the nerve can tear and become inflamed, leading to various symptoms. 

Symptoms of ulnar nerve entrapment at the elbow

Signs and symptoms of cubital tunnel syndrome usually occur gradually, progressing to the point where the patient seeks medical attention. Left untreated, cubital tunnel syndrome can lead to permanent nerve damage in the hand. Commonly reported symptoms associated with cubital tunnel syndrome include intermittent numbness, tingling, and pain to the little finger, ring finger and the inside of the hand. These symptoms occur more frequently at night, and with elbow bending or prolonged resting on the elbow.

Treatment options for ulnar nerve entrapment at the elbow

Your physician will initially recommend conservative treatment options to treat the cubital tunnel syndrome symptoms unless muscle wasting or nerve damage is present. Conservative treatment options may include wearing a brace or splint at night while sleeping to keep the elbow in a straight position. You can also wrap the arm loosely with a towel and apply tape to hold it in place.

If conservative treatment options fail to resolve the condition or if muscle wasting or severe nerve compression is present, your surgeon may recommend a surgical procedure to treat cubital tunnel syndrome.

Different surgeries are performed to treat your condition.

  • Medial epicondylectomy: This surgery involves removing the medial epicondyle, the bony bump on the inside of the elbow, enabling the ulnar nerve to glide smoothly when the elbow is flexed and straightened.
  • Ulnar nerve transposition: This surgery involves creating a new tunnel in front of the medial epicondyle and transposing (moving) the ulnar nerve to the new tunnel.

Your surgeon will decide which surgery would be best for you depending on your condition.

How is the surgery performed?

Medial epicondylectomy

If your nerve compression is mild, your surgeon may recommend a medial epicondylectomy. In this procedure, your surgeon will make an incision over the medial epicondyle, the bony bump on the inside of the elbow. The cubital tunnel is cut open through the soft tissue roof, exposing the ulnar nerve. The forearm muscles or flexor muscles are cut and detached from the epicondyle. Using special instruments, your surgeon will shave away the bump, freeing the ulnar nerve to glide smoothly within the cubital tunnel without pressure from the bump. The flexor muscles are then reattached to the area of shaved bone with special sutures. The incision is then closed with sutures and covered with a dressing.

Ulnar nerve transposition

More commonly, your surgeon may recommend an ulnar nerve transposition. Your surgeon will make an incision over the medial epicondyle. The cubital tunnel is cut open through the soft tissue roof, exposing the ulnar nerve. The forearm muscles or flexor muscles are cut and detached from the epicondyle. The ulnar nerve is transposed or moved from behind the elbow to a new location in front of the elbow. The ulnar nerve may be placed above the flexor muscle, within the muscle, or under the muscle. Your surgeon will decide which option is best for you. The flexor muscles are then sutured back together and reattached with special sutures to the epicondyle. The incision is then closed with sutures and covered with a dressing.

What are the risks and complications of ulnar nerve decompression surgery?

As with most surgical procedures cubital tunnel surgery may be associated with potential complications such as:

  • Infection
  • Nerve damage causing permanent areas of numbness around the elbow or forearm
  • Elbow instability
  • Elbow flexion contracture
  • Pain at site of scar
  • Symptoms not improved by the surgery
  • American Academy of Orthopaedic Surgeons
  • American Orthopaedic Association
  • American Association of Hip and Knee Surgeons
  • Society of Military Orthopaedic Surgeons