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Cubital tunnel release surgery is a surgical procedure performed to decompress the ulnar nerve at the elbow where it passes through the cubital tunnel. This procedure aims to alleviate symptoms of cubital tunnel syndrome, which include numbness, tingling, and weakness in the hand and fingers, particularly affecting the ring and small fingers.
The surgery can be performed under general or regional anesthesia and typically takes 30-60 minutes. The procedure begins with an incision made along the inside of the elbow, directly over the cubital tunnel. The surgeon carefully dissects through the soft tissue to identify and protect the ulnar nerve.
There are several surgical techniques available:
In-situ decompression involves releasing the tight tissue (Osborne’s ligament) that forms the roof of the cubital tunnel, allowing more space for the nerve without moving it from its natural position. This is the simplest approach and may be suitable for mild to moderate cases.
Anterior transposition involves moving the nerve to the front of the elbow after decompression. This can be performed as a subcutaneous transposition (relocating the nerve under the skin), submuscular transposition (placing the nerve under the flexor muscles), or intramuscular transposition (placing the nerve within the flexor muscles). The choice of technique depends on individual patient factors and surgeon preference.
Post-operative care typically involves immobilization of the elbow in a splint for 1-2 weeks. Physical therapy may be initiated after the initial healing period to maintain joint mobility and prevent stiffness. Most patients can return to light activities within 2-3 weeks and resume normal activities by 6-8 weeks, though complete recovery may take several months.
Success rates for cubital tunnel release surgery are generally favorable, with 85-95% of patients experiencing improvement in symptoms. However, outcomes may vary depending on the severity and duration of pre-operative symptoms. Patients with severe or long-standing nerve compression may experience incomplete resolution of symptoms.
Potential complications include infection, bleeding, nerve injury, elbow stiffness, and scar tenderness. Some patients may experience temporary increased numbness or tingling immediately after surgery as the nerve adjusts to its new environment. In rare cases, complex regional pain syndrome may develop.
Long-term outcomes are generally positive, with most patients experiencing significant improvement in nerve function and reduction in symptoms. However, some patients may need to modify activities or make ergonomic adjustments to prevent symptom recurrence. Regular follow-up is important to monitor recovery and address any complications that may arise.
The decision to proceed with surgery should be based on the severity of symptoms, failure of conservative treatment, and the presence of objective findings such as muscle weakness or nerve conduction changes. Patient selection and proper surgical technique are crucial factors in achieving optimal outcomes.
Cubital tunnel syndrome is a condition where the ulnar nerve becomes compressed or irritated as it passes through the cubital tunnel on the inside of the elbow. This tunnel is a narrow passageway formed by muscle, ligament and bone. When pressure builds up on the nerve, it can cause numbness, tingling, pain, weakness and clumsiness in the hand, particularly the ring and small fingers.
There are several factors that can contribute to the development of cubital tunnel syndrome. Leaning on the elbow for prolonged periods or keeping the elbow bent for long periods, such as while sleeping, can put pressure on the nerve. Fluid buildup, bone spurs, arthritis, prior fractures or dislocations, and cysts near the elbow joint can also narrow the cubital tunnel and compress the nerve.
Diagnosis of cubital tunnel syndrome starts with a thorough history and physical exam. The doctor may perform an elbow flexion test, where the elbow is bent for several minutes to see if it reproduces the symptoms. Tapping over the nerve to elicit tingling, known as Tinel’s sign, is another diagnostic maneuver. In some cases, electromyography and nerve conduction studies may be ordered to assess nerve function.
Initial treatment for cubital tunnel syndrome is usually conservative. Patients are advised to avoid activities that aggravate their symptoms and may be given a splint or brace to wear at night to keep the elbow from bending. Over-the-counter pain relievers, nerve gliding exercises, and occupational therapy may also be recommended.
If symptoms persist despite 6-12 weeks of conservative treatment, surgery may be considered to decompress the ulnar nerve. The most common surgical techniques are cubital tunnel release, where the ligament “roof” of the tunnel is cut to increase the size of the tunnel; ulnar nerve transposition, where the nerve is moved to a new position to prevent it from getting caught on the bony ridge of the elbow; and medial epicondylectomy, where part of the medial epicondyle bone is removed to create more space for the nerve.
Cubital tunnel release surgery is typically done as an outpatient procedure under regional or general anesthesia. A small incision is made on the inside of the elbow to access the ulnar nerve. After the nerve is decompressed using one of the techniques, the incision is closed with sutures and the elbow is immobilized in a splint.
Following surgery, patients can expect to wear the splint for 1-2 weeks until the sutures are removed. Physical therapy is then started to help regain range of motion and strength in the elbow and hand. Most patients can return to light activities within 3-4 weeks, but full recovery may take 3-6 months. While sensation and strength in the hand gradually improve, they may not return to normal in all cases.
As with any surgery, there are potential risks and complications associated with cubital tunnel release. These include infection, hematoma, persistent symptoms, elbow instability or stiffness, and painful scarring. However, with careful patient selection and appropriate postoperative rehabilitation, cubital tunnel release surgery is an effective treatment option for those with cubital tunnel syndrome that does not respond to conservative management. By decompressing the ulnar nerve, the procedure can help relieve the pain, numbness, tingling and weakness in the hand that can significantly impact a person’s quality of life and ability to perform daily activities.
©2025 Dr Frank McCormick All Rights Reserved.
©2025 Dr Frank McCormick All Rights Reserved.
