What is Ulnar Nerve Transposition?
Ulnar nerve transposition is a surgical procedure that moves the ulnar nerve from its natural position behind the medial epicondyle (the bony bump on the inside of the elbow) to a new location in front of the elbow. This prevents the nerve from being stretched and compressed during elbow bending.
The procedure is commonly performed for cubital tunnel syndrome when conservative treatments have failed, or when the nerve subluxates (snaps over the bone) with elbow movement. By relocating the nerve, the tension and compression that cause symptoms are eliminated.
Several techniques exist for transposition, with the choice depending on factors like the cause of compression, presence of subluxation, patient factors, and surgeon preference.
When is Surgery Recommended?
Surgical Techniques
Nerve moved to lie just under the skin in front of elbow
Advantages:
- • Simpler technique
- • Less dissection
- • Good for most cases
Considerations:
- • Nerve more superficial
- • Risk of direct pressure
Nerve placed within the flexor-pronator muscle mass
Advantages:
- • Good soft tissue coverage
- • Protected position
Considerations:
- • More dissection
- • Muscle splitting required
Nerve placed deep to the flexor-pronator muscles
Advantages:
- • Best soft tissue coverage
- • Most protected position
Considerations:
- • Most extensive surgery
- • Longer recovery
Nerve left in place, compression released (alternative)
Advantages:
- • Simplest technique
- • Preserves blood supply
Considerations:
- • Not suitable if nerve subluxes
- • May not address all compression
Recovery Timeline
What to Expect
- Pre-operative assessment and nerve studies
- Blood tests if required
- Stop blood thinners as advised
- Arrange transport home
- Usually go home same day
- Splint for 1-2 weeks
- Stitches removed at 10-14 days
- Physical therapy starts after 2 weeks
Important Information
- • Nerve recovery takes time: Numbness and tingling may take months to improve, and some patients have residual symptoms.
- • Early surgery = better outcomes: Prolonged compression can cause permanent nerve damage. Don't wait too long.
- • Muscle wasting may not fully reverse: If significant weakness existed before surgery, some weakness may persist.
- • Protect the surgery site: Avoid direct pressure on the inner elbow during recovery.