This outpatient procedure, performed under general or regional anesthesia, repositions the ulnar nerve to prevent it from sliding against or becoming pinched by the medial epicondyle (the bony bump on the inner side of the elbow).
Ulnar nerve entrapment is the second most frequent entrapment neuropathy in the upper extremity. Because of the anatomic arrangement of structures, the area around the elbow is the most common area for entrapment. The wrist at the Guyon canal is the second most common area of entrapment.
Because of the anatomic positioning of the ulnar nerve, it is subject to entrapment and injury by a wide variety of causes. It is the second most common entrapment neuropathy in the upper extremity (the first being the median nerve and its branches). Because of its superficial position at the elbow, it is often injured by excessive pressure in this area (leaning on the elbow during work or while driving a car).
The treatment of ulnar neuropathy at the elbow can be conservative (splint devices, physical therapy, rehabilitation) or surgical.
Nonsteroidal anti-inflammatory medications also are useful adjuncts to relieve nerve irritation. Oral vitamin B-6 supplements may be helpful for mild symptoms. This treatment should be carried out for 6-12 weeks, depending on patient response. Surgical intervention is indicated if increasing paresthesias occur despite adequate conservative treatment and at the first sign of motor changes.
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