What is ulnar nerve entrapment?Compression of the ulnar nerve at the level of the elbow is also known as Cubital Tunnel Syndrome. The ulnar nerve runs just behind the bony prominence on the inside of the elbow and is what people commonly think of as their “funny bone” when they knock this area. As the nerve crosses the elbow it passes through a tunnel and also a couple of other potential pinch points; this makes it vulnerable to the effects of any pressure or stretching.
As the floor of the cubital tunnel is bony, with very little cushioning tissue, direct external pressure or swelling around the elbow can compress the nerve against the bone. Prolonged periods of keeping the elbow bent can also cause stretching of the nerve, commonly this occurs without being aware of it when we’re asleep. In some patients, with movement of the elbow the nerve can slide forwards over the lip of the bony trough that forms the floor and sides of the tunnel; with this repeated flicking over the bone the nerve may become symptomatic.
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How is ulnar nerve entrapment diagnosed?The diagnosis of cubital tunnel syndrome can normally be made based on clinical assessment in the outpatient clinic. Nerve Conduction studies can be helpful to document the degree of pressure or damage to the nerve and guide prognosis for recovery following surgery. Occasionally an MRI (of the neck) may be recommended if it is suspected that a trapped nerve is masquerading as ulnar nerve irritation.
How is it treated?Initial treatment is often simple activity modification to try and avoid prolonged periods of leaning on the elbow or having the elbow bent for a long time. Using a pillow or splint at night to avoid bending the elbow can be helpful.
Should these measures fail to improve symptoms, or should there be evidence of more significant pressure of the nerve, then surgery to decompress the nerve may be recommended. Decompression of the nerve is usually done under a general anaesthetic (asleep) as a day-case procedure.
At the time of surgery, all of the common pressure points on the nerve will be released and the stability of the nerve within the bony groove behind the elbow assessed. Should the nerve, following decompression, show signs of being unstable and jumping out of the groove, then the nerve will be moved forwards out of the groove to sit in front of the elbow. This is known as a transposition.
For patients with signs of more severe compression over a prolonged period of time, the nerve has the ability to recover for up to two years after surgery, but may not be able to completely do so.
Driving can be resumed whensafe and able to do so, for most people this will be one to two weeks following surgery.
What are the potential complications?The risk of significant bleeding or infection is low following surgery. Swelling, discomfort and a degree of tenderness of the scar is to be expected in the first six to 12 weeks following surgery. The risk of damage to the main ulnar nerve or any significant branches is very rare. Occasionally one of the small branches to the skin on the inner aspect of the elbow may be affected leaving a permanent patch of numbness – this should not affect day-to-day activities with your arm. Some patients may experience residual symptoms, this is very much related to how much pressure the nerve is under prior to surgery, and occasionally symptoms may recur, but this is often many years down the line.
A big thank you to Simon and his team for their care, patience and perseverence looking after me through all stages of both shoulder and elbow surgery.
Since the shoulder stabilisation I have continued my sailing and fitness training without the worry that my shoulder might dislocate; and I don’t have to think twice whether my ulnar nerve will hinder any progression in my sports.
With their amazing help, I’ve been able to get back to sailing competatively and am now a double National champion.
After multiple shoulder dislocations Charlie helped me set a route for recovery, which has been nothing but smooth sailing. Surgery went successfully and I am well on my way to playing the sports I was previously. Would highly recommend.
Simon successfully operated on my frozen left shoulder in 2012 with fantastic results. This year he has overseen and advised treatment for my frozen right shoulder (via hydrodilation injection). His unrivalled experience in orthopaedic shoulder treatments, coupled with his reassuring bedside manner and excellent results, gave me huge confidence throughout. I’m hugely grateful to have my quality of life back and wouldn’t hesitate to recommend his services. Thank you Simon.
I had suffered with a painful shoulder and pins and needles for three years following a right shoulder fracture and failed half joint replacement prior to meeting Mr Pennington. He explained the situation in a way I could relate to and I’m delighted to say my revision shoulder replacement has gone well and for the first time in years I can use my arm and am pain free. I was even able to walk my daughter down the aisle 3 months after surgery! Many thanks.
I would like to thank Charlie Talbot and his team for the operations performed on both my shoulders and also the aftercare put in place after my operations. I have played golf since I was 12 years of age and thought at one point that I would never get back to playing again. Charlie was always very positive and told me that he would get me playing golf again. Well, I have now been playing golf for nearly 2 years. Before surgery I had a handicap of 12 and I am now down to 9, not bad at the age of 68. So many many thanks.
I had PRP injections into my right elbow last year and within 3 months I was pain free, a year on it is more or less 100% better. Fabulous I would recommend it to anyone with Tennis Elbow, in fact I have gone back again this year to get my left elbow done. Thanks Simon.
Mr Pennington I really wanted you to know how very thankful I am for the excellent care & treatment you and your staff gave me. It really meant a lot that you were so clear, friendly & professional and listened to me – so thank you again.
After more than four decades of shoulder problems with a total of three surgeries the full shoulder replacement surgery by Mr. Talbot has changed my life beyond expectations. I am now able bodied for the first time in years and pain free.
Thank you to Mr Boyle and team for the excellent care and attention both before and after Replacement Shoulder surgery, using the Tornier Simpliciti procedure. After very many months of severe pain and lack of movement I was pain free from day one. Now, after nine weeks, the shoulder and arm movement continues to improve, beyond expectation, with physiotherapy and exercise. I am extremely grateful for all the continuing care.
Following two years of recurrent problems with my left shoulder I was recommendedto Consult Mr Neil Pennington. I had the opportunity to have my surgery quickly and at my convenience, this fitted well around my professional and home commitments. The surgery was carried out as a day case procedure and Mr Pennington visited me following the surgery to explain everything. My operation was a minimally invasive procedure so my recovery was straightforward with only a few restrictions; in fact I was encouraged to keep my shoulder moving. I was driving and back to work after 2 weeks – after 2 years of pain and sleep disturbance I found this operation to be life changing! I found Mr Pennington to be a very professional and compassionate surgeon and he is surrounded by a whole team of professionals that gave me the utmost confidence in the care and treatment I received.
I would like to thank Mr. Talbot and the amazing team of nurses, physiotherapists and support staff for their care and support during my recent visit to the Duchy Hospital, Harrogate, for a replacement shoulder. The care and attention I received was unparalleled. The pain free movement I now have has changed my life.