As my grandma Loretta always used to say when she was upset, Shoot-a-bean! I had surgery two months ago to release some scar tissue around the nerve in my left elbow. It was a simple decompression operation on my ulnar nerve right by the funny bone. Well, this is no laughing matter because the symptoms have come back. Before I had numbness, tingling, and weakness of the ring and baby fingers. Now I have pain along with difficulty straightening those fingers. What do I do now?
Head on back to your surgeon's office for a recheck and possibly further treatment. You may not necessarily need more surgery, but keep that in the back of your mind as a potential treatment plan. These nerve entrapments can be very difficult to pinpoint and treat. Because there are so many places along the pathway of the nerve from the neck down to the fingers, one release may not be enough. It's possible there are other sites of nerve entrapment that must also be removed.
There are a couple of things you may be able do to alleviate the symptoms without surgery. One is to avoid extreme flexion of the elbow. This can put pressure on the ulnar nerve and irritate it enough to cause symptoms. You may need a splint to hold the elbow in a position of less than full flexion while sleeping. People who sleep all curled up with their arms held tightly against the body are at risk for ulnar nerve problems of this type.
It's also possible a physical therapist trained in neural (nerve) mobilization (movement) techniques can help out. By restoring the natural slide and glide of the nerve inside the nerve sheath (outer, protective covering), symptoms can be alleviated.
If these conservative measures don't help, then a second surgery may be needed to release any other structures pressing on the nerve. Ligaments, tendons, muscles, and even bone can put pressure on the ulnar nerve as it travels from the upper arm through the elbow down into the forearm, wrist, and hand. Moving muscles away from the nerve, moving the nerve away from pressing structures, and cutting off the funny bone (medial epicondyle) are just some of the ways this persistent problem can be dealt with.
Bradley A. Palmer, MD, and Thomas B. Hughes, MD. Cubital Tunnel Syndrome. In The Journal of Hand Surgery. January 2010. Vol. 35A. No. 1. Pp. 153-163.
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