SURGICAL PROCEDURE INFORMATION. Prepared For. Dr. Damien Tange F.R.A.C.S. Neurosurgeon. Ulna Decompression at the Elbow E U R O O B U S U L R G R Y

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1 U S M LBOURN NUROSURGRY SURGICAL PROCDUR INFORMATION Prepared For Dr. Damien Tange F.R.A.C.S. Neurosurgeon Ulna Decompression at the lbow R N N U R O O B U L M R Y R G 16 Walpole st Kew Victoria 3101 Australia

2 WHAT AR TH RASONS FOR HAVING SURGRY? The common reason is because you are suffering from a condition called Ulna Palsy from ulna nerve compresion at the elbow also called Ulna Nerve Syndrome ULNAR NRV SYNDROM is where the nerve that runs around the elbow to the hand is compressed. This nerve is called the Ulnar nerve. The nerve runs under a ligament around the elbow in a place commonly known as the Funny Bone (medial epicondyle). This ligament binds the nerve to the bone of the elbow and forms a tunnel for the nerve to run underneath. The nerve is travelling fron the upper part of the arm down to the fingers. It runs form the back of the arm(near your triceps muscle into the inside of the forearm it then runs down the inside of your arm(under some muscles) to the hand It has two major functions in the Hand. 1. It supplies the sensation to part of the hand(little finger and half ring finger) and 2. Impulses to drive some of the muscles in the hand. It also supplies some of the muscles in the fore arm but these are not usually affected. WHAT AR TH TYPICAL SYMPTOMS OF ULNA PALSY 1. Numbness in the little finger and typically half of the ring finger. 2. Symptoms worse with some activity. 3. Weakness in some functions of the hand(such as spreading out the fingers. The grip may decrease and there is a tendency to drop things. 4. Pain is not usually a feature. Position of the nerve under the skin of the hand Usual area of numbness

3 WHAT DOS TH SURGRRY INVOLV? The path the nerve takes is through a narrow channel it is opened by dividing the band over the nerve. The aim of the surgery is to relieve the compression on your nerve and in doing so hopefully improve or remove your symptoms. WHAT DOS TH SURGRRY INTND TO ACHIV? The surgery is done to try to improve any pain, weakness or numbness that you may have in your hand. If you are having surgery it usually means that the symptoms have not gone away with other therapies such as splinting,physiotherapy, rest, antiinflammatories, or injections. Some patients do get better with time and do not need surgery. The commonest reason is that the symptoms in your hand/s have been causing signifigant discomfort or that you have been getting worse. Usually non operative therapy has failed. AR TH SYMPTOMS OF ULNA NRV SYDROM ALWAYS FROM NRV COMPRSSION AT TH LBOW? No. Symptoms are what we feel. Other things can cause the same symptoms. This could be compression of the spinal cord or the neves in your neck. It may be from an underlying disease in the nerves such as a Peripheral Neuropathy. WILL ALL YOUR SYMPTOMS GT BTTR WITH SURGRY? This depends on the patient. Most will get substantially better and some will get complete resolution. This may depend on the amount of damage done to the nerve from the compression. Typically the numbness is the first to improve. The muscle strength will then get better next but any thinning of the muscle may not improve. The strength does not always return back to normal. Numbness should improve substantially but may not. In severe case it may take 9 months for this to be evident. The worst hand or finger always is the slowest to get better. The tips of the fingers are usually the last to get better and the most likely to have residual symptoms. WILL YOU GT BACK TO NORMAL? Again this depends on the patient. Some will and some will not. The aim is to make a substantial improvement in your symptoms but some patients see no change at all. Not all your symptoms may be able to be treated with surgery and this will depend on the severity and duration of your symptoms. COULD YOU ND FURTHR SURGRY? Yes. Some patients will get recurrence of their symptoms over time and the ligament may regrow and rethicken. COULD TH SURGRY MAK THINGS WORS? Yes. Some patients will get burning in the fingers of the hand after surgery as the nerves wake up from severe compression. This may or may not improve over time. this usually only happens in the worst compressed nerves. Some patients wil get pain in the elbow. This can be from the division of the ligament and mostly settles with physiotherapy. WILL TH SURGRY ALWAYS B DON AS DSCRIBD PR-OPRATION? Some times while the surgery is being performed it may be felt that to get adequate control of the situation or to prevent further deterioration in the future that a different type of procedure may need to be performed. This may just be a further extension of the existing procedure or a much more involved procedure. A smaller procedure may be done to reduce the risk of a later deterioration or because the operative findings are not as bad as suggested by your imaging or electrical tests. WHAT WILL HAPPN IF YOU DO NOT HAV TH PLANND SURGRY? Some patients will get some improvement in their symptoms, and may improve enough to not need the surgery immediately. The symptoms may not improve or may get worse. Sometimes if the compression to the nerves is left too long before decompression it reduces the chances of a complete or any improvement following surgery. The symptoms may deteriorate acutely and it can be best to arrange treatment at time that is convenient if it is felt that delay is acceptable.

4 HOW LONG WILL YOU B IN HOSPITAL? You are usually admitted on the day of surgery. A few patients are admitted the day before because of medical problems. You will need to fast from midnight on the day of surgery. The surgery is usually done as a day patient. This means that you will need some-one to bring you in and pick you up from hospital. You will be discharged about 3 hours post-operatively. Some patients may stay the following night after being admitted as a day patient if they have any complications or medical problems. On discharge you will be able to perform most tasks of daily living (e.g. showering/dressing/etc.) WILL IT B UNDR A GNRAL OR LOCAL? We usually offer the choice of having either but find most patients prefer to go off to sleep(general) for the surgery. HOW IS IT PRFORMD? The surgery is performed in a hospital by a trained neuro-surgeon and he will most likely have a surgical assistant. We will check the type of operation and the side of the surgery in the pre-anaesthetic room. We will mark the incison on your arm. In the operating theatre you are given a general anaesthetic or local anaesthetic by the anaesthetist. If it is under local then this will be injected into the region of the incision at this time (a sedative is given by the aneasthetist to help the operation pass). The small incision marked is prepared with antiseptic. You are covered in drapes so that only the incision can be seen. If you have the surgery under a general then loca is injected a this time to help with bleeding and early postoperative pain. Incision on inside of elbow Ulna Nerve Cut ligament skin incision internal incision Flexor Carpi Ulnaris A cut is made through the skin down to the fat. Any nerves are identified. A retractor is used to hold the edges of the skin away. He will then cut through the band over the nerve with a sharp blade. The decompression will be well beyond the incision on your elbow. It extends into the arm and into the forearm. The surgeon then makes sure all the bleeding has stopped and sews the skin back together. A dissolvalbe suture is usually used to close the wound edges. The wound is covered with a dressing and crepe bandage. A further wad of cotton wool and crepe are used to cover the first dressing. You will then go to recovery. The outer crepe and cotton wool will be removedprior to going home.

5 WHAT HAPPNS NXT? You will wake up in recovery and after about 1 hour you will be transferred to the ward. The nursing staff will be continually checking your pulse/blood pressure/limb strengths and sensation looking for any changes to indicate a complication. You will probably only need oral analgesia. We will encourage you to keep your hand elevated. Most people will be able to go home the same day. It is important that some-one drives you home afterwards The sutures are usually dissolvable but if not are removed about 7-12 days after the surgery. This should have been arranged prior to your discharge from hospital. It is usually done by a nurse. this may be at your local doctors / our practice / the ward at the hospital you had your surgery. WHAT YOU SHOULD NOTIFY YOUR DOCTOR OF AFTR SURGRY 1. Increasing Pain in the wound/elbow 2. Fever 3. Swelling Redness or infection in the wound. 4. Increasing or new onset weakness or numbness in the hand or fingers. 5. Anything that concerns you about your arm WHAT MIGHT YOU FL AFTR SURGRY? It is commmon to have worse numbness after the surgery for the first 24 hours. This may occur as the local anaesthetic may seep down onto the decompressed nerve and will take time to resolve. If the hand developes more numbness after you leave recovery you should contact your surgeon. WHAT HAPPNS WHN YOU GO HOM? (See the postoperative leaflet for more information) If you smoke it is best to try to give this up. 1. The covering bandage can be removed the next day. The other dressing should be changed daily from the second day or if it gets wet. 2. You will have an early follow-up appointment to have you wound reviewed. 3. You are encouraged to try to keep the hand elevated and to use it as much as possible. 4. You must not lift anything heavy with the hand until told you can do so by your surgeon 5. Sometimes you will need Physiotherapy. 6. It is important to keep the hand dry. 7. Your doctor will discuss driving and return to work with you. CAN I HAV BOTH NRVS DON AT TH SAM TIM? We suggest to do one arm at a time. It is difficult to function with both elbows sore and having limited capacity. We will do the worst nerve first. WHAT YOU ND TO TLL TH DOCTOR BFOR SURGRY? If you have clotting problems. Any recent new Health problems or heart disease. If you are taking blood thinning agents. e.g. Warfarin / aspirin/anti- inflammatory If you have improved from the time you decided to have surgery. Drug allergy Any thing that you think is important for the doctor to know in making his decision to offer you surgery.

6 Some of the possible complications are: WHAT AR TH RISKS? Discuss these and any concerns you have with your surgeon Infection (treated with antibiotics) Damage to the nerve that is compressed. This may cause weakness, numbness and/or chronic pain Damage to the adjacent nerves usually causing some numbness in the forearm. May need surgery to repair or may not improve Damage to structures around the nerve. Artery / tendons etc. Post operative blood clot requiring drainage Wound breakdown Scar formation Infarction or death of the nerve. Damage to the nerve from the local anaesthetic. Surgery on the wrong arm. Chronic pain in the elbow. Death Recurrent nerve compression Symptoms may be made worse Further surgery may be required Blood transfusion Medical complications not related directly to the surgery e.g. Clot in the legs (can travel to the lungs [uncommon]) Pneumonia Heart attack Urine infection Kidney failure Stroke Drip or catheter infection WHAT AR TH COSTS OF TH SURGRY? Discuss this with your surgeon There are out of pocket costs for the surgery above the amount you will get back from your health fund. It is important to discuss this with your doctor and to contact your fund to understand not only the cost of the surgeon but also the costs of the hospital admission and other people involved. The assistant will send an account for 20% of the value of the surgeons fee. If you have no health insurance and wish to have the surgery privately then you should discuss with the office staff to organize an estimate. YOU WILL B ASKD TO SIGN A CONSNT FORM TO SAY THAT YOU UNDRSTAND ANY RISKS. IF YOU AR NOT SUR ASK BFOR YOU SIGN. If you feel that you need a second opinion we recommend that you ask your local doctor to arrange an independent opinion for you. M LBOURN NUROSURGRY PHON FACSIMIL MLBOURN NUROSURGRY PTY LTD ACN This brochure is copyright. No part of it may be reproduced in any form without prior permission from the publishers.