Ulnar nerve transposition

Surgical procedure to move ulnar nerve

What is ulnar nerve transposition?

An ulnar nerve transposition is a surgical procedure in which the ulnar nerve is physically moved to address conditions such as an ulnar nerve subluxation or recurring cubital tunnel syndrome. Ulnar nerve transposition does not only address compression of the ulnar nerve but also in conditions where ulnar nerve traction is present.

Ulnar nerve traction happens when repetitive tugging, stretching, and pulling leads to irritation to the point that function of the nerve is compromised. The effect of a compromised ulnar nerve is felt from the elbow to the little and ring fingers, with the occasional symptoms manifesting on the upper arm and shoulder. 

Ulnar nerve
The effect of a dysfunctional ulnar nerve is felt along the hand, forearm, and the last two fingers.

An ulnar nerve transposition is necessary when procedures such as a cubital tunnel release are considered ineffective at significantly improving symptoms. In comparison to a cubital tunnel release, an ulnar nerve transposition is a major surgical procedure that needs to be conducted with higher levels of precaution as it is significantly riskier and more complex. 

Symptoms that one may require an ulnar nerve transposition surgery include:

  • Unresolved pain that is persistent despite prior medical management 
  • Parenthesis causing numbness, tingling, and unmanageable discomfort at the ring and small finger 
  • Weakness in the hand followed by signs of atrophy in the arm 
  • A sensation of a “sleeping” arm, indicating poor neural connection and reduced motor functionality of the arm
  • Clawing of fingers (typically the little and ring finger) 
  • Persistent snapping sensation at the elbow
Ulnar nerve transposition
Clawing fingers are an indication that an ulnar nerve transposition is required.

How does ulnar nerve transposition work?

Following your orthopaedic evaluation, imaging tests such as x-rays and magnetic resonance imaging (MRI) will be conducted to confirm surgery suitability. A surgery date will then be assigned. 

During the surgery, incisions are made at the back of the arm. The ulnar nerve is then mobilised from the back of the medial epicondyle to the frontal area to address potential impingement or entrapment. It is also possible that the nerve is moved to lie within a muscle (transmuscular transposition) for better nerve function. Extra precaution is taken in ensuring the motor branch of the nerve is not harmed. 

Upon transposing/moving the ulnar nerve, the new location is secured with sutures. Your surgeon will ensure the site is not too tightly stitched as that would cause further constriction. The surgical site is then cleaned to prevent infection and incisions are subsequently closed. 

Benefits of ulnar nerve transposition

  • Improved motor function 
  • Relief from pain 
  • Alleviation from numbness and discomfort 
  • Increased mobility 

What conditions can ulnar nerve transposition treat?

Ulnar nerve transposition can treat the following conditions:
  • Post-traumatic ulnar neuropathy: dysfunction of the ulnar nerve following an injury. 
  • Ulnar nerve subluxation: ulnar nerve subluxation is the partial dislocation or abnormal movement of the ulnar nerve. 
  • Ulnar neuropathy post decompression: recurring compression and dysfunction of the ulnar nerve that does not resolve with cubital tunnel release
  • Arthritis: arthritis such as rheumatoid arthritis makes one prone to cubital tunnel syndrome.
  • Fractures: fractures can cause bits of bones or cartilage to break away and compress the ulnar nerve. 
  • Dislocation: elbow dislocations typically result in movement of the elbow structures which could subsequently lead to compression.
elbow pain
Ulnar nerve transposition can be used to treat cubital tunnel syndrome.

What results can I expect?

Typically it could take anywhere between 3 to 6 months for recovery to take place. However, this is highly dependent on the extent of damage to the ulnar nerve and the severity of each case. An ulnar nerve transposition is reported to have high levels of satisfaction due to its capacity to relieve symptoms. One can expect improvement in sensory capabilities and improved arm strength. In the cases of athletes and returning to sports, a promising outcome of a high return rate to sports is observed. 

It is important to note that treatment does not end at surgery. Following an ulnar nerve transposition procedure, patients need to participate in aggressive rehabilitation to address muscle atrophy in most cases. Whilst many ulnar nerve transpositions have high capabilities of addressing issues related to compression, entrapment, and impingement, discipline and dedication towards physiotherapy are key to complete recovery. 

Diets and post-surgical habits could also impact your healing rate. With positive post-surgical care and collaborative work with your orthopaedist, a positive outcome can be anticipated. 

Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances. 

How many treatment sessions are needed?

An ulnar nerve transposition is a one-off treatment without the need for follow-up surgeries. Additionally, this particular procedure has low reoperation rates. If ever required, they are usually conducted to address prior faulty surgical methods. 

However, the rate of subsequent elbow injury following an ulnar nerve transposition is significant. This could be due to improper lifestyle practices or lack of precaution that makes one vulnerable to subsequent injuries. It is important that one practises strict post-surgical regimens to avoid recurring surgery.

Your orthopaedic surgeon will be able to provide you with a bespoke treatment plan, tailored to your needs and requirements.

Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.

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For emergency appointment, please call or Whatsapp us at (65) 8909 8877. We will arrange for a limousine to send you to our clinic.
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