What is Nerve Transposition?

Nerve transposition is a surgical procedure that involves relocating a nerve from its original anatomical position to a new, safer location. This is typically done to relieve chronic nerve compression, prevent recurrent irritation, or protect the nerve from mechanical stress.

At Katranji Hand Center, the most commonly performed nerve transposition is for the ulnar nerve at the elbow (cubital tunnel syndrome), where the nerve is moved to relieve pressure and reduce symptoms of numbness, tingling, and weakness.

Causes

Nerve transposition is often performed due to:

• Chronic nerve compression syndromes (e.g., cubital tunnel syndrome)

• Recurrent entrapment after prior decompression surgery

• Subluxing nerves – where the nerve dislocates or “snaps” over bone during movement

• Trauma or scarring around the nerve

• Anatomical abnormalities that increase pressure on the nerve

Signs & Symptoms

Patients who may need nerve transposition often experience:

• Numbness and tingling, especially in the ring and small fingers (ulnar nerve)

• Weakness or muscle wasting in the hand

• Pain at the elbow or forearm

• Symptoms worsening with elbow flexion (e.g., holding a phone, sleeping)

• Nerve "snapping" or shifting with movement

Diagnosis

At Katranji Hand Center, evaluation includes:

• Detailed clinical examination – assessing sensation, grip strength, and muscle atrophy

• Tinel’s sign – tapping over the nerve to reproduce symptoms

• Elbow flexion test

• Nerve conduction studies (NCS) and EMG – to confirm compression and assess severity

• Ultrasound or MRI – in certain cases to visualize nerve position or surrounding structures

Treatment Options

Non-Surgical Management

• Activity modification (avoiding prolonged elbow flexion)

• Nighttime elbow splinting

• Anti-inflammatory medications

• Occupational therapy

• Corticosteroid injections (in select cases)

Surgery is recommended if symptoms persist or if nerve damage progresses.

Surgical Nerve Transposition

Commonly performed as:

• Subcutaneous transposition – nerve moved just under the skin

• Submuscular transposition – nerve repositioned beneath muscle layers

• Intramuscular transposition – nerve embedded within muscle to protect it from movement stress

Steps typically include:

1. Careful dissection and release of the compressed nerve

2. Mobilization of the nerve to prevent tension

3. Transposition into a new anatomical location

4. Securing the nerve in its new bed with soft tissue or muscle coverage

Postoperative Care

• Arm may be immobilized in a splint for 1–2 weeks

• Elevation and icing to reduce swelling

• Gradual return to movement and function

• Hand therapy to regain strength and coordination

• Full recovery often occurs over 6 to 12 weeks, though nerve recovery may continue for several months

Associated Risks

While generally safe, potential risks include:

• Persistent numbness or weakness

• Recurrence of symptoms

• Nerve injury or irritation

• Scar tissue formation

• Elbow stiffness or muscle soreness

Prognosis

When performed appropriately, nerve transposition significantly reduces symptoms and prevents further nerve damage. At Katranji Hand Center, our team ensures precise technique, early intervention, and coordinated therapy to help patients regain comfort, strength, and function in their daily lives.