Ulnar Nerve Decompression Surgery in Sharjah

What is ulnar nerve decompression surgery?

Ulnar nerve decompression surgery releases the tissue pressing on the ulnar nerve. This nerve gives feeling to the little finger and half of the ring finger, and it powers most of the small muscles that give the hand fine control and a firm pinch. It has two common pinch points, and the operation depends on which one is involved.

At the elbow, the nerve runs through the cubital tunnel, a groove behind the bony bump on the inner side of the elbow, roofed by a band of tissue. Bending the elbow stretches the nerve and narrows this tunnel. At the wrist, the nerve passes through Guyon's canal, a short channel on the little-finger side of the palm, between two small wrist bones.

A simple clue helps tell the two apart. A branch of the ulnar nerve leaves above the wrist to supply the back of the hand on the little-finger side. When that patch on the back of the hand is numb too, the trouble usually lies at the elbow; when it feels normal and only the palm side and fingers are affected, Guyon's canal becomes the likelier site. At Dar Al Kamal Hospital, Sharjah, both releases are carried out by the neurosurgeon, and they are among the operations outlined on the peripheral nerve surgery page.

Who needs it

At the elbow, pressure builds with an old elbow fracture, arthritis, habits that keep the elbow sharply bent for hours, or a nerve that flicks over the bony bump each time the elbow bends. At the wrist, the usual causes are a ganglion, a fluid-filled lump growing inside the canal, repeated pressure on the heel of the hand from cycling handlebars or motorbike grips, and using the palm as a hammer at work.

Surgery is considered when tingling persists despite a night splint, padding and changes in grip, or when the hand shows signs of a struggling nerve:

• a hollow appearing between the thumb and index finger on the back of the hand
• difficulty crossing the middle finger over the index finger
• the ring and little fingers starting to curl
• the thumb bending at its tip when you pinch a sheet of paper, a sign doctors call Froment's sign

A nerve conduction study pinpoints the pinch point and shows how badly the nerve is affected. For Guyon's canal, an ultrasound or MRI looks for a cyst. Sometimes the median nerve is trapped at the same time, and carpal tunnel release is planned alongside. The surgeon explains the options for your hand, and the timing is decided with you.

What happens

Ulnar nerve decompression is usually done under a regional anaesthetic that numbs the arm, or a general anaesthetic, and the anaesthetist agrees the choice with you. It is often a day case.

At the elbow, the surgeon makes a curved incision along the inner side of the joint, divides the band forming the roof of the cubital tunnel, and follows the nerve above and below to release any further tight points. The elbow is then bent and straightened on the table to watch how the nerve behaves. If it stays settled in its groove, a simple release is enough. If it slips forward over the bone, the surgeon moves it to a new bed in front of the elbow, a step called anterior transposition, so the nerve lies slack whenever the arm bends. Some surgeons instead smooth down part of the bony bump, a step called medial epicondylectomy.

At the wrist, a short incision on the little-finger side of the palm opens the roof of Guyon's canal. Any cyst is removed, and the nerve's branches for feeling and for the hand muscles are traced and freed.

The skin is closed with fine stitches under a padded dressing. After a transposition, a splint may support the elbow for a short period.

Preparing for it

Bring your nerve conduction report, any scans and a full list of your medicines, including blood thinners. People with diabetes should review their blood sugar control beforehand, as steady levels help healing. Remove rings from that hand before the day, because the fingers swell.

Wear a shirt with a wide or short sleeve that slides easily over a bulky dressing; a loose kandura or abaya works well. Practise one-handed tasks at home, such as opening jars and fastening clothes. Arrange a lift home, and if the operation falls in Ramadan, discuss timing, medicines and fluids with the team early.

Afterwards

Move your fingers fully from the first day to keep them supple. Rest the arm on a pillow rather than leaning on the elbow, and follow the surgeon's guidance on elbow movement, which is stricter after a transposition. Night-time tingling often eases first. Numbness and muscle strength return more gradually, as the nerve recovers from the release site down towards the fingers, and a hollow between the thumb and index finger fills slowly.

The inner-elbow scar can feel sensitive for a while, and gentle massage once it has healed helps. Hand therapy is arranged by referral for pinch and grip exercises. Your surgeon gives you a timeline for your work: desk work, delivery riding and manual work each follow a different plan. In the Sharjah heat, keep the dressing dry and drink plenty of water.

Contact the hospital if the wound becomes red, hot, swollen or leaks, if you develop a fever, or if the numbness or weakness in your hand clearly worsens.

Cost and insurance

Most UAE insurance plans cover ulnar nerve decompression when it is medically needed. Insurers usually require pre-approval supported by a nerve conduction report, and imaging of the wrist may need its own approval. Hand therapy sessions are often approved separately with their own limit. Dar Al Kamal Hospital, Sharjah can help you confirm your cover on 06 599 7777.