What is cubital tunnel syndrome?Cubital

Cubital tunnel syndrome is a condition in which too much pressure is placed on the ulnar nerve.  The ulnar nerve is a nerve that supplies sensation to your small and ring fingers.  It also activates the muscles within your hand.  The ulnar nerve becomes compressed as it crosses on the inside of the elbow.  This is the nerve you irritate when you hit your “funny bone”.  The nerve becomes compressed at or near the elbow by ligaments, muscles, and sometimes even blood vessels.  Sometimes the nerve is also noted to sublux or dislocate over the bone in the elbow.  This can often give a “popping” sensation and can cause pain.

What are the symptoms of cubital tunnel syndrome?

Often people complain of numbness and tingling in the ring and small fingers.  Often the numbness and tingling occur at times when the elbow is resting on a hard surface or during activities that require elbow flexion.  As the nerve also innervates muscles to the hand one might also note a decrease in grip strength.

How is cubital tunnel syndrome diagnosed?

In our practice it is most often diagnosed by history and physical exam.  On occasion, a nerve conduction test will be ordered to confirm the diagnosis.  However, as this test is uncomfortable we try to avoid this testing.

What is the treatment for cubital tunnel syndrome?

In most cases, the initial treatment is nonoperative.  A trial of elbow pads and activity modification is tried at first.  However, often these modalities fail and surgery is required.

What does cubital tunnel surgery involve?

The simplest operation to treat cubital tunnel is a cubital tunnel release.  The nerve is identified at the elbow and all constricting structures are identified and released over the course of the nerve.  If the nerve is noted to sublux or dislocate over the elbow with elbow flexion then move extensive surgery is required.  In this case the nerve is freed and relocated in front of the elbow.

What are the main risks of this surgery?

• Swelling, stiffness, and pain
• Infection
• Nerve Damage
• Injury to the elbow joint or forearm muscles
• Residual numbness in fingers
• Recurrence

Post Operative Course

Day 1-2
• Keep dressing clean and dry
• Elevate hand above heart level for next 48 hours to prevent pain and swelling
• If no splint is in place after 48 hours you may remove dressing and get incision wet in shower
• After showering apply antibiotic ointment and a dressing
• In all cases move digits as much as possible to prevent stiffness
• If no splint you are encouraged to move elbow to prevent stiffness
Day 3-14
• If no splint continue local wound care with antibiotic ointment and bandaid
• Splint will be removed at one week.  Resume elbow motion as comfortable
• Continue to move digits.  You may lift whatever you are comfortable lifting.  There is nothing you can damage.
Day 14-3 months
• It may take this long for residual discomfort to resolve
• Continue to progressively use your elbow and hand
• It may take this long for symptoms to improve.  Nerve recovery can be slow

Driving?
You may drive when you are off narcotics and feel confident to control the car.  Most patients are able to drive within a week or two.

Time off of Work?
This is dependant on the type of work you perform and whether the nerve needed to be relocated.  Many patients with office jobs only require a few days.  However, patients who perform heavy labor may require 4-6 weeks to recover.