What Is Elbow Decompression Surgery? Ask a Shoulder Surgeon

What is Elbow Decompression Surgery?

Elbow decompression surgery is a procedure to correct ulnar neuropathy. The ulnar nerve is the part of the elbow more commonly known as the ‘funny bone’. Striking the funny bone can cause a temporary tingling sensation in the arm. If an injury is severe enough to cause compression of the ulnar nerve, this tingling sensation may persist indefinitely. There may also be numbness in the ring finger or pinky finger, as well as pain in the inner elbow and forearm.

How Does the Ulnar Nerve Become Compressed?

The ulnar nerve runs from the brachial plexus (a large branch of nerves in the shoulder), passing along the medial border of the upper arm through the biceps and triceps. It then travels deep through the cubital tunnel around the elbow joint, along the posterior medial border of the forearm and down through the wrist, ending below the pinky finger.

Ulnar compression results from damage to the ulnar nerve in or around the cubital tunnel. Scar tissue, inflammation or dislocation of the joint capsule can restrict space within the cubital tunnel, compressing the nerve and pinching it. This sensation is worsened when the elbow is flexed.

Elbow decompression surgery is recommended if analgesia and immobilization of the elbow does not relieve symptoms. Clinical assessment and a series of nerve conduction tests are used to determine the cause of the neuropathy.

What Does Elbow Decompression Surgery Involve?

Decompression is most often performed under light general anesthetic by a neurosurgeon. The aim of the procedure is to relieve neural compression, reduce pain and prevent further deterioration of the nerve.

An incision is made along the posterior medial border of the arm in order to expose the ulnar nerve. The surgeon then divides the band of tissue constricting the nerve. Scar tissue may also be divided up, and any abnormal growths compressing the nerve are removed. A small amount of bone may also be removed (medial epicondylectomy).

Surgery usually takes around 20-40 minutes and does not require overnight stay.

In more serious cases, the elbow operation performed by the orthopedic surgeon may need to seek repositioning the ulnar nerve along a new pathway in the elbow (ulnar transposition). This procedure is used when the cubital tunnel has been occluded by growths, or the bony condyles surrounding the nerve are severely damaged. This is usually only necessary if a previous neurolysis procedure has failed or the elbow is deformed. This method poses a slightly higher risk of complications as the surgeon must ensure an adequate blood flow to the nerve area. However, both surgeries are considered safe and effective.

Recovery from Elbow Decompression Surgery

Following surgery, the arm will be bandaged from the wrist to the elbow in order to protect the incision and keep the wound clean. The bandage must be kept dry and the arm should be elevated as often as possible.

Bending and straightening the elbow, wrist and fingers at least 5-6 times a day helps to maintain mobility and prevent stiffness. It is also advised to exercise the shoulder by raising the arm overhead several times a day

The fingers and wrist may be used for light movement such as typing, but heavy lifting must be avoided for at least three months.

Elbow decompression is successful in the majority of patients, with only a minority suffering further complications. Most regain full use of their hand, wrist, and elbow within 4-5 months.

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