Identify the ulnar nerve proximally along the medial border of the triceps.
Release the ulnar nerve through the cubital tunnel up until the first motor branch by incising the flexor-pronator aponeurosis as the nerve passes between the two heads of flexor carpi ulnaris.
Whenever possible, take care to preserve the perineural vessels.
The nerve may be transposed or left in situ according to the surgeon’s preference, but it should be tension free and not in contact with suture material or metalwork at the end of the procedure.
Take care to protect and be mindful of the nerve throughout the entire procedure.
Pitfall: If a vessel loop or sling is used around the nerve, it is recommended to avoid an artery clip on the loop to minimize inadvertent traction on the nerve.
Note: If the ulnar nerve has been mobilized, it is essential that the OR report should clearly describe how the ulnar nerve has been protected and the location of the nerve at the end of the operation.