Peripheral nerves can be compressed along their trajectory, from origin to tip, as they pass through canals made up of bony and fibrous elements. In the case of the ulnar nerve at the elbow, it is important to distinguish between situations where the osteo-fibrous canal, located inside the joint, plays a primary role and can be decompressed at various levels, and secondary cases resulting from specific causes, such as inflammation of the synovial tissue lining the elbow joint or fracture sequelae. In situations secondary to specific causes, it is necessary both to release the nerve and, in some cases, to treat the source of the compression. When the osteo-fibrous canal is predominant, compression can occur at various points: at the exit of the canal when the nerve passes under the fibrous arch of the wrist flexor, behind the internal bony projection (epicondyle), or more proximally when it crosses the internal fascia of the arm. Not only is the presence of exclusively subjective damage corresponding to stimulation of the sensory areas of the nerves of the hand in the 4th and 5th fingers important, but so is the age of the damage. An electrophysiological study (recording of the current conducted by the nerve) confirms the site of ulnar nerve compression at elbow level. Sometimes, this becomes even more significant. This is followed by objective sensory deficits, reduced sensory awareness in the 4th and 5th fingers, and motor deficits, initially associated with reduced grip strength and then progressively more of the small muscles of the hand (amyotrophy). Treatment of ulnar nerve compression at the elbow is often surgical, although some authors suggest immobilizing the elbow with a night splint in the early stages. Surgical interventions to release the nerves and decompress are generally performed under local anesthesia of the upper limbs. First, open the arch through which the nerve passes in the distal part of the canal. If compression at this point is good, and the nerve is stable in its groove during flexion/extension, this simple gesture is sufficient to clear the obstruction. In other cases, the neural groove is unstable and permanently crosses the medial crest of the elbow during the transition from extension to flexion, causing inflammation due to this instability. The thickness of this bony prominence can be reduced (superior synovectomy), or the nerve can be taken out of the groove and passed in front of the superior synovium. The humerus is the medial part of the lower end of the humerus. In the post-operative stage, it can be mobilized immediately, but in some cases, a splint that immobilizes the elbow for several days may help. Development is often characterized in early forms by the rapid disappearance of pain and sensory deficits. If there are objective deficits associated with nerve fiber destruction in the elbow, and nerve repair is performed at 1 mm per day, a wait of 6 months or more is required to restore sensitivity and strength.
If the problem persists over a very long period of time, there’s no going back. No surgical procedure is without risk of complications. – If diagnosed early, postoperative infection is fairly easy to control, causing abnormal pain, throbbing, swelling and marked redness, and reoperation is possible at any time. – Painful swelling of the elbow followed by stiffness, a rare but worrying complication (algesic dystrophy) that can also affect the hands and shoulders. It develops slowly, and can have lasting effects (pain, stiffness in fingers and wrists, and even shoulders) for months or even years. – Nerve damage is abnormal. – Recurrence is rare, but not totally excluded. Surgeons are in the best position to answer any questions you may have before or after surgery. Don’t hesitate to consult them again before making a decision.
