Dallas Ulnar Nerve Surgeon

Ulnar nerve entrapment occurs at the cubital tunnel, a narrow passageway formed by bone, muscle, and ligaments near the elbow, specifically behind a bony bump called the medial epicondyle. The ulnar nerve is one of the three major nerves in the arm and is responsible for sensation in the ring and little finger (pinky) and supports hand strength. When the ulnar nerve becomes compressed, known as cubital tunnel syndrome, this can lead to intermittent numbness, tingling, and weakness.

It is important to note that these commonly reported symptoms occur gradually and may worsen with activities that involve bending the elbow, which — activities which may include things like holding a phone, or driving. In highly rare yet severe cases, muscle wasting or atrophy in the hand muscles can occur, indicating severe nerve compression or permanent nerve damage. Nerve compression symptoms may also be reviewed in patients with a history of elbow injuries such as a biceps tendon tear or triceps tendon tear, or conditions involving bone spurs, ganglion cysts, or soft tissue swelling that increase pressure on the ulnar nerve.

The Procedures & Treatment Options

Before considering elbow surgery, patients should be aware that it is possible that many cases of ulnar nerve entrapment can be effectively managed with conservative treatment options. The purpose of these non-surgical approaches is to aim to reduce pressure on the ulnar nerve, decrease pressure within the cubital tunnel, and alleviate symptoms such as numbness and tingling in the ring finger and little finger. These common conservative options include, but are not limited to things like— activity modification, bracing or splinting with elbow pads to prevent swelling and protect the nerve, anti-inflammatory medications to increase blood flow and reduce inflammation, and physical therapy.

Ulnar nerve entrapment surgery involves cubital tunnel release or ulnar nerve transposition surgery. This surgical procedure addresses nerve irritation or damage. Efficient recovery after an ulnar nerve entrapment procedure requires adherence to your doctor’s instructions, including postoperative care and physical therapy to restore muscle strength and range of motion. Below are some general guidelines to follow for a successful recovery, though your ulnar nerve doctor may provide specific guidance, which always takes precedence.

FAQS

It is important to be mindful of activities that involve prolonged or repetitive bending of the elbow, leaning on the elbow, or gripping objects tightly can worsen symptoms.

These examples include but are not limited to:

– Holding a phone to your ear for extended periods, which can compress the nerve against the overlying ligament.
– Sleeping with a bent elbow, causing the nerve to stretch and potentially irritate the nerve at the elbow formed by the medial epicondyle.
– Typing or using a computer mouse for excessive durations, which may aggravate symptoms by affecting arm function and fine movements.
– Lifting heavy objects, especially if you hold your arm loosely or in a straight position, placing additional strain on the nerve.

Nerve gliding exercises are specific movements designed to help the ulnar nerve travel and glide smoothly through the cubital tunnel.

Cubital tunnel syndrome exercises can help to do the following:

– Reduce nerve tension
– Improve nerve mobility
– Decrease symptoms like numbness and tingling by ensuring the nerve moves freely in the appropriate position within the affected area.

Ulnar nerve transposition surgery is usually considered if conservative treatment options fail, there is evidence of significant nerve compression or muscle weakness or symptoms are worsening over time.

Diagnosing ulnar nerve entrapment by your Dallas ulnar nerve specialist typically involves a:

– Thorough physical examination. Here your ulnar nerve transposition doctor will review your medical history, assess your sensation, strength, as well as the reflexes in your hand and fingers, including examination of the neck region to rule out nerve issues originating there.

– Tinel’s sign: Tapping on the ulnar nerve at the elbow, specifically around the medial epicondyle and the passageway called the cubital tunnel, to see if it causes tingling.

– Nerve conduction studies: Nerve tests to measure how well the ulnar nerve is functioning and to pinpoint the site of compression.

– EMG (electromyography): Electromyography and nerve conduction measure the electrical activity in muscles to detect nerve damage.

What to Eat or Drink Following Your Procedure

There are no restrictions on your diet following Ulnar Nerve transposition surgical procedure, but there are some things you can do to reduce feelings of nausea or digestive discomfort:

Following your procedure, stick to light foods and clear liquids for at least the first 48 hours.
As you resume your normal diet, you may experience nausea from heavy, greasy meals. Contact our office if you experience extreme nausea or vomiting.
Stay hydrated by drinking plenty of water. You may supplement with electrolyte beverages.

Caring for Incisions

Your incisions require special care to promote efficient healing and reduce the risk of infection. Your Dallas ulnar nerve doctor will provide specific care instructions, but below is some general guidance for incision care following Ulnar Nerve Entrapment surgery:

Do not remove your surgical dressing. Our office will remove it for you at a follow-up visit.
You may experience swelling and spotting around the inner side of the elbow. This is normal, but if your dressing becomes saturated, cover it with sterile gauze and contact our office.
Do not allow the incision area to get wet. You may shower starting 24 hours after your procedure, but cover the incision site with a waterproof plastic cover. Getting the incision area wet raises the risk of infection.
Do not apply topical products to the incision area unless directed by your doctor. If itching becomes a problem, contact our office for guidance.
Our office will remove stitches or sutures at a follow-up appointment, typically around 1-2 weeks following your procedure. Your doctor will provide guidance on showering at that time. Do not immerse your incision area in a bath, pool or hot tub until cleared by your doctor.

Pain and Medication Guidelines

*The following are general aftercare guidelines for the use of medications. Your doctor will provide specific instructions as they pertain to your health, prescriptions and procedure.

Local anesthesia from the procedure will begin to wear off 6-10 hours following your procedure. You may notice a peak in pain and discomfort around day 2-3. Swelling may also increase around the inner elbow and forearm.
You have been prescribed pain medication. Take this as directed. Do not take more than the recommended dose. If you feel that your medication is ineffective at dealing with your pain, contact our office for guidance.
Prescription pain medications can cause drowsiness and dizziness. You’re encouraged to have a caregiver with you for the first 24–48 hours following your discharge. If you experience constipation, an over-the-counter stool softener may provide relief.
Do not attempt to drive until cleared by your doctor. Pain medications can reduce your reaction time and diminish motor skills, and your brace, split, or sling may impair your ability to pilot a vehicle safely.
If you are at a high risk of blood clot formation, discuss this risk with your doctor. A low-dose aspirin regimen may be ordered during your recovery.

Your Mobility Following an Ulnar Nerve Entrapment Procedure

For the first week, rest with your arm supported in the provided brace, splint or sling. Your elbow should maintain a slightly flexed position of around 45-90 degrees.
Use the provided brace, splint or sling 24 hours a day for 1-3 weeks or as directed by your doctor. Avoid prolonged elbow bending beyond 90 degrees. Do not lean on your elbow.
To reduce swelling, avoid prolonged periods of sitting or long-distance travel for the first few weeks following your surgery.
Do not attempt to drive until your doctor clears you to do so.
When you return to work, discuss adjustments in your duties to include tasks that do not require the use of your operative arm.

Proper Usage of Your Brace, Splint or Sling

Wear the prescribed brace, posterior splint or sling for 1-2 weeks or as directed by your doctor.
The brace, splint or sling is essential for protecting the ulnar nerve and surgical site from pressure or strain. It must not be removed without explicit guidance from your care team.
If you need help with hygiene or brace adjustments, contact our office for guidance. Do not attempt to make adjustments on your own as this can harm the repair.

Use a Cold Pack for Swelling

Apply a cold pack, ice or prescribed cooling device over the incision area to reduce pain and swelling. This should be done for 20-30 minutes every 2-3 hours for the first week.
Do not apply ice or other cold therapy directly to your skin. Always use a protective barrier, such as a towel or cloth, between the ice pack and your skin to prevent frostbite
Always place a protective barrier, such as a towel or cloth, between the ice pack and your skin to prevent frostbite.

Movement and Stretching Guidelines

Your doctor will provide guidance on finger and wrist flexion or extension exercises. You may perform these exercises beginning 24-48 hours following your procedure unless otherwise directed by your doctor. Avoid forceful gripping or repetitive elbow motions.
Perform approved exercises 2-3 times each day to promote healthy circulation and prevent stiffness in the hand and wrist.
If you have been ordered to receive physical therapy, our office can help you make an appointment.

CALL US IF…

Reach out right away if you notice:

214 265 3271

Severe, persistent pain that does not improve with medication or radiates through your upper arm.
Fever, chills, infection, redness, off-color discharge.
Severe swelling, tingling, numbness or skin discoloration, particularly in the hand, fingers or forearm.
Respiratory distress or chest discomfort.
Bleeding or persistent fluid leakage at the incision site.

Ulnar nerve symptoms can be debilitating. You don’t have to put up with the discomfort. Schedule your appointment with a Dallas Ulnar Nerve Surgeon

Dr. Thornton also provide treatment for elbow conditions such as golfer’s elbow and tennis elbow. Contact Dr. Thornton’s office to learn about effective treatment strategies and start your journey towards a healthier life!

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