Ulnar sulcus syndrome – Treatment

Procedure

If the symptoms and electrophysiological changes associated with sulcus ulnaris syndrome are mild, conservative treatment can be used instead of surgery. The movements and postures of the elbow that cause discomfort are avoided. If necessary, an elbow sleeve with a pad can be worn over the nerve. Nerve gliding exercises can be carried out in hand therapy.

If conservative treatment is of no use, or if there are already pronounced sensory disturbances, muscle atrophy and/or a significant deterioration in the nerve’s conduction capacity, surgery is necessary. This procedure involves cutting the ligament that spans the ulnar sulcus. Depending on the situation, the nerve can be left in the canal (simple decompression) or moved to the front of the elbow.

Simple decompression can be performed openly via a longer skin incision in the area of the inner surface of the elbow or under camera view (endoscopically) via a smaller skin incision directly in front of the ulnar sulcus. An advancement can only be performed openly via a larger incision. The nerve is placed either in the subcutaneous fatty tissue, in the musculature (intramuscular) or under the musculature (submuscular) of the inner elbow.

Aftercare

If only the ligament is split during the operation and the nerve is left in place, a bandage and rest for two weeks are sufficient. If the nerve is moved forward under the muscles, the elbow and wrist are immobilized for two weeks so that the detached muscles can grow back. Full weight bearing is possible after two to six weeks, depending on the surgical method. Nerve gliding exercises can be carried out in hand therapy.