Nerve Compression
Overview
Nerve compromise in the arm can happen at any level but at the elbow, compression of the ulnar nerve under the bony prominence on the inner aspect (medial epicondyle) is the most common. The other most common site of compression is of the median nerve at the wrist. These are called cubital tunnel and carpal tunnel syndrome respectively.
While presentation of cubital tunnel syndrome may be of pain at the elbow, more commonly numbness in the little and ring finger and that side of the hand are the symptoms. In carpal tunnel syndrome, the thumb, index and middle finger dominate.
With increasing severity, the muscles of the hand may become weak and function can deteriorate as the muscles waste due to lack of nerve stimulation. When this starts to occur surgical intervention to decompress the nerve before the deficit is too severe is important as recovery of the motor function even with surgery is unpredictable.
The distribution of symptoms related to nerve compression does not always adhere to the usual distribution and overlap between nerves can occur. When the level or nerve involved is in question, nerve conduction studies with a neurophysiologist may be necessary in advance of intervention. These may direct us to relieve a nerve at either the wrist or the elbow.
Treatment
Initial splinting to relax the nerve and sometimes injection where an inflammatory element is involved are reasonable options but if the symptoms are significant a nerve release is often necessary. In my practice this is done under general anaesthesia for releases at the elbow and under local for those at the wrist. These can usually be done as a day case. Occasionally moving the nerve in front of the medial epicondyle is required. This is known as a transposition.
Aftercare
Following surgery, a bulky bandage is required for a few days but there are usually no specific restrictions. It is sometimes the case that symptoms may get worse before they get better but in general people do see an improvement within the first 3 months. Where severe motor loss in the hand is already established, the degree of recovery may be limited however. The goal of the surgery in this instance is prevention of further deterioration rather than reversing losses.
Patients: see our advice sheets on what to expect from your procedure and how best to manage afterwards
Physios: see our therapy guidelines for post-operative care
