Will my numbness go away after ulnar nerve transposition surgery?

In my experience, numbness due to cubital tunnel syndrome post-surgery takes a long time to resolve. It may take 1 to 2 years to resolve completely, and unfortunately for some, it may never be 100%.

Patients who are treated earlier seem to achieve better results as compared to patients who receive treatment later as nerve compression ailments are time-sensitive - the longer the nerve is compressed, the more the damage and the more likely the damage is permanent and irreversible.

A good analogy to a nerve is a blood vessel supplying oxygenated blood to a muscle. Once the blood vessel is compressed and obliterated, oxygenated blood may no longer reach the muscle, and the muscle will start necrosing and die. Once the muscle becomes necrotic and dies, it fibroses and becomes hard, dead tissue.

This process is irreversible. In the case of a nerve, the nerve transmits impulses to and from the end-organ. The end-organ may be:

• sensory,
• motor or
• proprioceptive.

When the nerve is chronically compressed, transmission of signal is obliterated. This causes the end-organ to become dysfunctional. The longer this dysfunction is allowed to continue, the more irreversible the dysfunction becomes. Therefore, sensation to the skin supplied by the nerve may not recover fully and motor function of the muscle supplied by the nerve may not be fully active despite treatment. This is what chronic neuropathy may result in. Suffice to say, for treatment of nerve conditions, the earlier, the better.

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