This is a condition in which the ulnar nerve, which is a large nerve that runs in a groove at the back and inner aspect of the elbow (supplying muscles in the forearm and hand as well as sensation to the little and ring finger), becomes pinched or trapped. It is characterised by pain at the back and inner aspect of the elbow associated with pins and needles or numbness radiating down the inner aspect of the forearm into the little and ring fingers.
Symptoms often first develop at night although, as the pinching becomes more severe, daytime symptoms will be present as well. Patients may also notice that they become clumsy, ie dropping items easily, and have a reduced grip strength. Diagnosis is based on clinical examination which can confirm the irritability of the nerve at the back of the elbow. Investigations include nerve conduction studies (NCS) which are specific nerve tests that will diagnose this condition in most patients. Symptoms may be aggravated by excessive or prolonged elbow flexion such as holding a phone to the ear and these prolonged or repetitive activities such be minimised. If symptoms are very significant or worsening then the most effective long-term solution is surgery to release the pinching of the nerve at the back of the elbow. As with many conditions surgery is generally most effective when performed early in this condition as if the nerve has been trapped for a prolonged period of time (in excess of twelve months) the nerve may not fully recover and consequently pins and needles and numbness may persist even after the nerve has been released.
Often in younger patients they will present with similar symptoms but in these patients the symptoms are often caused by the nerve subluxating out of its normal groove and flicking forwards over the bony prominence on the inside of the elbow as the elbow is fully bent. Non-operative treatment is ineffective in treating a subluxing nerve and this will require surgery to relieve the symptoms.
Surgery to treat the condition is called an ulnar nerve decompression. The operation is performed under general anaesthetic as a daycase procedure (patient goes home on the same day). A small incision is made on the inner side of the elbow and the ulnar is released form any tissue that is compressing it. If the nerve is unstable then the nerve is moved to the front part of the elbow to stop it flicking over the bony prominence on the inside of the elbow. This is known as a transposition of the nerve and is only performed when the nerve is unstable. The wound is closed with dissolvable stitches under the sling and the patient wakes up with their arm in a sling. It takes approximately 2 weeks to return to driving and non-manual work. It often takes 6 weeks before returning to manual work. Risks of the operation include infection, hameatoma (blood clot), nerve damage, incomplete relief of symptoms, recurrence of symptoms or need for any further procedure.