64718 Neuroplasty and/or transposition; ulnar nerve at elbow

Name of the Procedure:

Neuroplasty and/or transposition of the ulnar nerve at the elbow

Summary

Neuroplasty and/or transposition of the ulnar nerve at the elbow is a surgical procedure to relieve pressure on the ulnar nerve, which runs along the inner part of your elbow. This procedure helps reduce pain, numbness, and weakness in the hand and fingers by freeing the nerve or moving it to a less restrictive location.

Purpose

The procedure addresses ulnar nerve entrapment (cubital tunnel syndrome), which causes pain, numbness, and tingling in the ring and little fingers, weakness in the hand, and difficulty with finger coordination. The goal is to alleviate these symptoms and improve hand and finger function.

Indications

• Persistent numbness or tingling in the ring and little fingers
• Weakness in the hand
• Muscle wasting in the hand
• Pain on the inside of the elbow
• Failed conservative treatments like splinting or physical therapy

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Adjustments to medications as directed by the physician.
• Preoperative assessments, such as nerve conduction studies or electromyography (EMG), may be required.

Procedure Description

1. The patient is positioned, usually lying on their back with the arm extended.
2. Anesthesia is administered (general or regional).
3. A surgical incision is made along the inner part of the elbow.
4. The ulnar nerve is located and gently freed (neuroplasty), or moved to a new location (transposition) to relieve pressure.
5. The incision is closed with sutures and a sterile bandage is applied.

Tools and technology: Scalpel, retractors, sutures, possible use of endoscopic instruments for minimally invasive techniques.

Duration

Approximately 1-2 hours.

Setting

Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Possible presence of a surgical technician

Risks and Complications

• Infection
• Bleeding
• Nerve damage or persistent symptoms
• Scarring or adhesion formation
• Blood clots
• Anesthesia-related risks

Benefits

• Relief from pain, numbness, and tingling
• Enhanced hand and finger function
• Improved quality of life

Recovery

• Keep the surgical site clean and dry.
• Elevate the arm to reduce swelling.
• Use of a sling or splint as directed.
• Physical therapy may be recommended.
• Full recovery typically takes a few weeks to a few months.
• Follow-up appointments to monitor healing and nerve function.

Alternatives

• Conservative treatments: physical therapy, splinting, and anti-inflammatory medication.
• Corticosteroid injections.
• Pros: Less invasive and lower risk.
• Cons: May not provide lasting relief and might delay necessary surgery.

Patient Experience

During the procedure, general or regional anesthesia will ensure you feel no pain. Postoperatively, you may experience mild to moderate pain managed with medication, temporary numbness, and swelling. With proper care, symptoms generally begin to improve within a few weeks.

Pain management may include prescription painkillers and over-the-counter analgesics. Comfort measures such as ice packs and elevating the arm can also help reduce pain and swelling.