This handout explains the follow-up care after surgery to transpose the ulnar nerve at the elbow. The pressure around your ulnar nerve has been relieved and the nerve has been moved to the proper position in your elbow, to relieve pressure and avoid instability. Because the nerve has been moved, there is often some irritation producing some numbness and tingling in your ring and small finger for several hours or days, which is normal. You have a drain in place to remove fluid from around the surgery site and to decrease the risk of infection. Please continue to take your antibiotics until the drain has been removed. We can schedule removal of the drain for you at our office in 2 days, or the nurse can instruct you on how to remove this at home. A splint has been set in place to maintain your thumb in as straight a position as possible. Please do not lift anything with the operative hand until instructed to do so after therapy. If the splint feels tight, it’s okay to unwrap and rewrap the Ace bandages.

If the skin around the incision is red or if there is drainage coming out of it please call us right away. The phone number is at the bottom of this page. Go to the emergency room if this occurs at night or on a weekend. You will be scheduled to begin a therapy program within a week after surgery to introduce gentle range of motion exercises and to make a more comfortable splint once swelling has decreased. If you do not have an appointment to begin post-operative therapy, please contact our office and we will coordinate that for you.

Wound Care:

  • After surgery, your arm will be placed in a bulky splint to prevent rotation of your forearm. This helps to protect the surgical site and lessen swelling. When bathing, put a plastic bag around your arm to keep the splint clean and dry.
  • Elevate your arm as much as possible to lessen the swelling and pain.

Pain Management:

  • You will receive a prescription for narcotic pain medication. Take the pain medication as it is prescribed taking the right dose at the right time to best manage your pain. As it takes about 1 hour for the medication to take effect, it is important to “stay ahead” with your pain medication and avoid having to play “catch up” for a significant increase in pain.
  • Medication for nausea may also be provided. Please make sure to take this as directed, typically placed under the tongue (sublingual) to be absorbed in the mouth.
  • Please make sure to check with the postoperative nurse or the Bellevue Bone & Joint Physicians staff about how to manage your pain medication.
  • Please see the “Medications After Surgery” form for more instructions.
  • If you have uncomfortable side effects from the pain medication please call us.
  • It is normal to have some pain off and on for approximately one year after surgery particularly in cold weather.

Driving:

  • Do not drive if you are taking narcotic medication, as it is unsafe and against Washington state law. Taking medication can make you sleepy and delay your reaction time.
  • Once you are no longer taking narcotic medication you may drive as soon as you can comfortably grip the steering wheel with both hands.

Activity:

  • You will have very little use of the operative arm for about 8 weeks after surgery until the tissue heals.
  • Do not lift anything heavier than a pencil or pen until your sutures have been removed and you have been advised to advance your activity by your physician or therapist.

Follow-Up:

  • If a drain is installed to prevent fluid from accumulating in the surgical site, it can be removed by BBJP hand therapy within 3 days following surgery. Oral antibiotics should be taken 4 times a day until the drain is removed.
  • The sutures will be removed beginning 10-14 days after surgery.
  • Your arm will be placed in a splint or cast depending on the level of protection needed.
  • A hand therapist will help to teach you exercises to lessen the scarring around the incision, improve range of motion, and when appropriate increase your hand and arm strength.

Results:

Many patients who have ulnar nerve transposition surgery will regain full use of their arm. Stiffness is common after surgery and decreases with use. Shooting electrical pains may occur, but should decrease in frequency and intensity over time. Rubbing the skin using materials with different textures can reduce hypersensitivity at the surgical scar.


Thomas E. Trumble, M.D.

*Figures courtesy of Principles of Hand Surgery and Therapy by Thomas E. Trumble, MD, Ghazi M. Rayan, MD, Mark E. Baratz, MD and Jeffrey E. Budoff, MD