Cubital tunnel syndrome affects the ulnar nerve at the elbow, causing symptoms in the arm and hand. When non-surgical treatments fail or symptoms worsen, cubital tunnel surgery may be considered. This procedure aims to relieve pressure on the ulnar nerve, restoring function and alleviating discomfort.
What is Cubital Tunnel Syndrome?
Cubital tunnel syndrome occurs when the ulnar nerve, one of the three main nerves in the arm, becomes compressed or irritated as it passes through the cubital tunnel at the elbow. This tunnel is a narrow passageway of bone, muscle, and ligaments on the inside of the elbow, through which the ulnar nerve travels behind the bony bump known as the medial epicondyle. The nerve controls sensation in the ring and little fingers and powers most of the small muscles in the hand.
Pressure on the ulnar nerve can develop from activities like leaning on the elbow or repetitive bending. Symptoms include numbness and tingling in the ring and little fingers, often worsening when the elbow is bent. Patients may also experience elbow or forearm pain, weak grip, and hand clumsiness due to muscle weakness. Diagnosis involves a physical examination and may be confirmed with nerve conduction studies or electromyography (EMG). Surgery is considered when conservative treatments fail or when there are signs of severe nerve damage or muscle weakness.
Surgical Approaches
The procedure is typically performed as an outpatient surgery. It can be done under general anesthesia (patient asleep) or local anesthesia to numb the arm, sometimes with a sedative. An incision is made on the inner side of the elbow to access the ulnar nerve.
Cubital tunnel release, also known as in-situ decompression, involves cutting Osborne’s ligament, which forms the roof of the cubital tunnel. This enlarges the tunnel and reduces pressure on the ulnar nerve, allowing it more space to move freely. The surgeon inspects the nerve before closing the incision.
Ulnar nerve transposition is another technique, moving the nerve from behind the medial epicondyle to a new location in front of it. This prevents the nerve from stretching or becoming irritated during elbow bending. Types of transposition include subcutaneous (under the skin), intramuscular (into the muscle), and submuscular (underneath the muscles). The specific technique depends on the patient’s condition and surgeon’s assessment.
After the Surgery
After cubital tunnel surgery, recovery involves managing pain and protecting the surgical site. Pain medication is prescribed to manage discomfort, and patients are advised to use ice packs and elevate their arm to reduce swelling. The incision will be covered with a dressing, which needs to be kept clean and dry for a few days. Stitches or staples are removed at a follow-up appointment around two weeks after surgery.
A splint or sling may support the arm and limit elbow movement. Heavy lifting and strenuous activities are restricted for several weeks, but gentle finger and wrist movement is encouraged to prevent stiffness. Physical or occupational therapy often begins in the weeks following surgery to regain strength, flexibility, and range of motion. Adherence to post-operative instructions is important for proper healing and optimal outcomes.
What to Expect Long-Term
Long-term recovery from cubital tunnel surgery varies, with many patients experiencing significant improvement in symptoms. Numbness and tingling may improve quickly, though full resolution can take up to six months or even a year. Strength in the hand and grip typically returns within a few months, but complete recovery can extend up to 12-18 months, particularly in severe cases. The overall success rates for cubital tunnel surgery are generally good, especially for patients with milder symptoms or those who have had the condition for a shorter duration.
While surgery is generally safe, there are potential, though rare, complications. These can include infection at the incision site, issues with wound healing, or persistent numbness around the elbow due to irritation of smaller nerves. In some instances, the ulnar nerve itself may be injured during surgery, which can lead to worsening symptoms.
Rarely, symptoms may not fully resolve or could recur, potentially requiring further intervention. Most patients can return to light work within a few days to two weeks, while more physically demanding jobs may require 4 to 8 weeks or longer for a safe return.