Ulnar Nerve Decompression and Transposition

Indications

  • Cubital tunnel syndrome failing night splinting
  • In situ decompression gives similar results to transposition
  • Transposition when the nerve subluxes or for revision
  • Severe neuropathy with intrinsic wasting or weakness
  • Nerve conduction studies localise the lesion and grade severity
  • McGowan grading describes severity from sensory symptoms to intrinsic paralysis

Position

  • Supine, arm table, tourniquet
  • Arm abducted with the shoulder externally rotated

Operative Steps

  1. Curved incision behind the medial epicondyle
  2. Protect branches of the medial antebrachial cutaneous nerve
  3. Release Osborne ligament and the FCU fascia distally
  4. Flex the elbow to check for subluxation
  5. For transposition, release the arcade of Struthers and excise the medial intermuscular septum proximally
  6. Release distally to avoid a new kink
  7. Anterior subcutaneous transposition held with a fascial sling
  8. Endoscopic in situ release is an alternative
  9. Medial epicondylectomy is another option for subluxing nerves
  10. Submuscular transposition for revision or thin patients

Postoperative Care

  • Early motion
  • Soft dressing and sling for comfort
  • Full motion within the first weeks
  • Sensory symptoms improve before motor recovery
  • Return to manual work at about 4 to 6 weeks

Complications

  • Medial antebrachial cutaneous neuroma
  • Persistent or recurrent symptoms
  • Nerve devascularisation with transposition
  • Elbow flexion contracture
  • Medial elbow instability after epicondylectomy
  • Complex regional pain syndrome

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.