Introduction
In mild or very early cubital tunnel syndrome, non-operative treatment may be suggested, with splinting and activity modulation to prevent activities where the elbow is very flexed which can exacerbate the condition. If the symptoms are more severe, then surgery is required to release the ligament compressing the nerve. Sometimes it is also necessary to bring the nerve round to the front of the elbow where it is under less tension. This is known as anterior transposition of the nerve.
Indications
Surgery is indicated if conservative treatment has been ineffective or if the condition is severe, particularly if there is weakness of the muscles supplied by the ulnar nerve
Preoperative Instructions
The procedure is usually day surgery and you will be admitted on the morning of the surgery. The hospital will discuss the time of arrival and fasting arrangements. You would not normally have to stop any regular medication prior to this minor procedure but Dr Stewart can advise you about your specific requirements.
Procedure
Under general anaesthetic, an incision is made on the inside of the elbow, over the ulnar nerve. The ligament is released and the nerve is freed from any compressing tissue. If the nerve is then unstable or a transposition is already planned, the nerve is brought to the front of the elbow to avoid additional tension.
Postoperative Instructions
If a simple cubital tunnel decompression is performed, then you will go home on the same day. Where a transposition has been performed, an overnight stay is advised. A bulky bandage with be around the elbow for the first week and you will have a simple dressing for a further week after that. Full recovery is expected in around 6 weeks.
Risks
Surgery for cubital tunnel syndrome is generally very effective, but occasionally there can be some persistent pain in the scar at the elbow which can last for several months. In rare cases where there is damage to some of the small nerves in the area there can be long-term pain and numbness in the forearm.
Treatment Alternatives
If splinting is not effective in relieving the symptoms then surgery is the best option for cubital tunnel syndrome. Steroid injections are unlikely to be effective. Different surgical procedures are described but simple decompression with anterior transposition when necessary is a reliable option.