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Will my numbness go away after ulnar nerve transposition surgery?

Hand Surgery Orthopaedic Surgery

I am a 28 years old female. I've been experiencing persistent numbness after a bilateral ulnar nerve transposition surgery 3 months ago. The post-surgery nerve conduction studies showed that sensory and motor results are all fine, but the EMG results explained that there was still evidence of chronic ulnar nerve neuropathy. I was told by both my neurologist and surgeon that the numbness should go away with time, but I am still worried. What should I do next?

DOCTOR’S ANSWER (1)

I'm sorry to hear that you are still symptomatic after your surgery.

It is certainly unusual for you to have symptoms of cubital tunnel syndrome in both hands at the same time.

As you are already seeing both a neurologist and a hand surgeon, I am sure a variety of tests were already performed to establish your diagnosis before surgery.

There are various types of surgery for cubital tunnel syndrome (ulnar nerve impingement at the cubital tunnel of the elbow). These can range from simple decompression where the nerve remains in the tunnel and the roof of the tunnel released; to an anterior transposition, where the nerve is brought to lie in front of the medial epicondyle. 

A simple decompression widens the tunnel and may be adequate for some patients, but the nerve may still be vulnerable to stretching and continued irritation when bending the elbow. 

 

An anterior transposition type of surgery moves the entire nerve from the tunnel, to lie in front of the medial epicondyle bone, ensuring all sites of potential compression are released, and let the nerve lie in a more direct path without any further tension. This procedure is more extensive and most patients start to feel an improvement to their numbness in 2 to 3 weeks although complete resolution may take longer.

The swelling and inflammation following surgery can cause transient irritation to the nerve with the sensation of numbness or pins and needles, and this is expected, but should improve day by day, and should resolve by 4 to 6 weeks.

I would advise patients that during this period to continue to exercise precautions avoiding excessive activity requiring elbow flexion, while performing light protected elbow range of motion exercises for 10 minutes 4 to 6 times a day to avoid elbow stiffness and gradually restore function (an occupational therapist or physiotherapist can assist with this).

Where there is persistent numbness after surgery, it would be wise to outrule other potential causes of numbness, including a compression of the nerves higher up (commonly in the neck or cervical spine), hormonal or other systemic causes of numbness such as thyroid disorders, autoimmune disorders and nutritional deficiencies for example. These may require further imaging (e.g. MRI of the neck), and blood tests. 

Repeat nerve conduction and EMG studies can be performed to compare values before and after surgery, but these tests may be affected by the post-operative inflammation and oedema, and nerves do take in excess of 6 weeks to recover their electrophysiological function after decompression.

Occasionally, where no other causes are found, and there is persistent numbness and/or worsening symptoms or pain, a re-exploration may be required to outrule a mechanical cause or technical issue (eg. Scar tissue, adhesions, tethering, kinking etc. of the transposed nerve).

Best Regards,

Dr Jonathan Lee


Dr Jonathan Lee
MA, MB BCh BAO, MRCSEd, MMed(Surg.), FAMS

The Aesthetic Studio Singapore | Dr Jonathan Lee Hand, Wrist and Upper Limb Surgery

Mount Elizabeth Medical Centre
3 Mount Elizabeth #12 - 08
Singapore 228510


2423 views 17 May 2018
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