The ulnar nerve is more commonly referred to as the "funny bone". When this nerve becomes compressed there is nothing "funny" about it. This nerve supplies sensation to the little finger and half of the ring finger. The ulnar nerve runs under a ligament around the elbow in the medial epicondyle. This ligament binds the nerve to the elbow and forms a tunnel for the nerve to run underneath. Common symptoms are numbness in the little and ring fingers, weakness in some funtions of the hand, and symptoms worsen with activity.

The most common causes are:

• Thickening of the muscle the nerve runs into after leaving the fascial tunnel
• Thickening of the ligament over the nerve
• Repetitive trauma to the nerve
• The most common reason to have the surgery is that you are having significant discomfort or that you have been getting increasingly worse, and other therapies have failed to produce results.

The initial diagnosis will be based on your symptoms. Once you see a specialist he will most likely order a conductive nerve study. This test is noninvasive and consists of electrical impulses being sent down the arm. If the nerve is compressed or damaged, the electrical impluses will be impeded.

The operation is called an Ulnar Nerve Decompression and can be performed under either general or local anaesthetic. Most of the time you will be able to go home the same day. Regardless of the type of anaesthesia you will not be allowed to eat or drink anything after midnight the night before. Before the surgery begins the staff will confirm the arm that is to be operated on and will draw the incision on the skin with a special pen. The anaesethic will be given at this time (if local a tournequet is used most of the time) and the arm is cleaned off with antiseptic solution and the arm is covered with sterile drapes leaving only the area of the incision exposed.

The surgeon cuts throught the skin and fat down to the first layer. he will then cut through the fascia over the muscle and the nerve with a sharp knife. Once the nerve is identified as it runs behind the bone on the inside of the elbow, the nerve is then decompressed where it enters the muscle in the forearm. Once the nerve is decompressed, the surgeon will make sure that all the bleeding is stopped and will then close the skin with sutures. The wound is then covered with a dressing and a crepe bandage and a pressure dressing used to cover the first dressing.

You will wake up in recovery and after about 1 hour you will return to your room. The nurses will continue to monitor your vital signs and arm strengths and sensations looking for any changes to indicate a problem. Most people go home the same day. You will have to have someone drive you home afterwards.

The sutures, if not absorbable, will be removed approximately 10 days later.

You should notify your doctor after surgery if any of the following occurs:

• Increasing pain in the wound/elbow
• Fever
• Swelling or signs of infection in the incision area
• An increase of or new onset of weakness or numbness in the hand or arm

Once you go home, the covering bandage can be removed the next day. The other dressing should be changed daily beginning on the second day or if it gets wet. Once the incision is closed you may take this dressing off. You will have a followup visit with your doctor soon afterwards to check on the incision and healing progress. You should also keep the arm elevated for the first few days and use it as much as possible. It is very important that you not lift anything heavy with that arm until your doctor tells you that it's ok to do so. It is also important that you keep the wound dry.

The most common risks with this surgery are infection, post operative blood clot requiring drainage, nerve damage, elbow pain, scarring from the incision, and failure to improve. Will your symptoms improve? In the great majority of cases yes. If the nerve is badly damaged then recovery may be very slow or not at all.