The patient came to the clinic 04-June-2003 telling that she was operated for left CTS without improvement 23-September-2001. She started to complain of numbness of all hand for 36 months and the left ulnar division for 1 year. ECS and EMG done 14-September-2001 telling moderate bilateral CTS and bilateral ulnar palsy at elbow more the left. Not diabetic. MRI cervical spine done 17-March-2002 showing bulge C5-6 and C6-7.

On examination: The patient has hypalgesia left ulnar nerve tributaries. The patient was sent for through lab investigations to rule out neuritis or neuropathy.

Projectional incision over the left ulnar nerve. The ulnar nerve exposed above and below the groove. The bands over the ulnar nerve dissected and the nerve hanging free. The groove was dissected off the periostium and the bone part was drilled deeper to give move depth and space to the nerve. The periostium was returned back and sutured to prevent future callus formation.  Routine closure of the wound.

Smooth postoperative recovery. She was sent to the ward.

She came 15-June-2004  with clean wound  telling that slight improvement was noticed.  ECS done 21-September-2003 showing some improvement in the record.

Instead of transposing the ulnar nerve and causing damage to the near lying branches, it is more logical to release the nerve and drilling the bony groove to give the nerve more depth and space without transposing it. Preservation of the periostium is very important to prevent future callus formation.