Cubital Tunnel Release

Ulnar Nerve Decompression versus Transposition

This illustration shows the path of the ulnar nerve through the cubital tunnel. Structures that may compress the nerve--such as medial epicondyle and ulnar collateral ligament--are also shown.
Reproduced from J Bernstein (ed): Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

Cubital tunnel release is a treatment option for cubital tunnel syndrome, which is the compression of the ulnar nerve in the cubital tunnel – a passageway for the nerve right behind the bony bump on the inside of the elbow.

The ulnar nerve is located close to the skin’s surface and is commonly referred to as the “funny bone.” The nerve can become pinched at one of several places along its course, resulting in loss of blood flow to the nerve. This can cause numbness or tingling in the ring and small fingers of the affected hand. In advanced cases, it can lead to weakness and muscle damage in the hand, which can produce significant functional difficulties when using the affected hand.

Continue reading for more detailed information about cubital tunnel release surgery. To learn more about the causes and symptoms of cubital tunnel syndrome, click the button below:

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Surgical Treatment Option: Cubital Tunnel Release

Cubital tunnel release is a surgical procedure that involves ulnar nerve decompression, and for some, a transposition of the nerve as well:

  • During the procedure, a 3-inch incision is made along the course of the ulnar nerve, and the roof of the cubital tunnel is opened to relieve pressure on the nerve.
  • Once the nerve has been decompressed, the elbow is taken through a range of motions to determine whether or not transposition is also necessary. A transposition is necessary about 20 percent of the time:
    • If the nerve remains stable behind the bony bump, then only decompression is needed.
    • If the nerve is unstable after pressure is relieved, the surgeon enlarges the incision and repositions the nerve from behind the bony bump on the inside of the elbow to the front. This is called a transposition.

The incision is closed using dissolvable sutures, and the arm is placed in a bulky dressing to be removed 10-14 days after surgery. Overall results are similar for both procedures.

Preparing for Surgery

Cubital tunnel release is performed under general anesthesia.

Avoid medication that can thin the blood, such as anti-inflammatories, aspirin, Vitamin E or Coumadin, for at least seven days before surgery. In most cases, you will be able to resume taking these medications again the day after surgery.

Because this approach involves general anesthetic, patients may not eat or drink anything after midnight the night before surgery unless otherwise specifically instructed (for diabetic patients, we will make every attempt to schedule your procedure as the first case of the day). You will be allowed to slowly resume eating right after surgery, but you will need to designate a friend or family member to be there after surgery to receive your discharge instructions and drive you home.

What to Expect After Cubital Tunnel Release Surgery

Dressing and sutures: It is important to keep the dressing clean and dry so it must be covered while showering. The dressing will typically be removed 10-14 days after surgery. As the stitches are dissolvable and under the skin, there are no sutures to remove. After the dressing has been removed, you may shower with the wound uncovered, but do not immerse the area of the incision for 3-5 days. Do not use ointment of any kind on the incision. A sling can be used for comfort as needed.

Recovery: Early motion is allowed, but you should not lift, push or pull anything greater than a pencil for six weeks after surgery. Overall recovery time varies by individual. It can take at least 2-3 months before you start to regain normal use of the extremity. Physical therapy is often needed and starts six weeks after surgery. Improvement in the numbness can be immediate, but in some patients, it can take months to get better.

Driving: Patients should not drive while taking pain medicine and should minimize driving until the dressing is removed.

Work: If your job does not require use of the arm that was operated on, you may return to work when you feel comfortable doing so.

Results: Results vary depending on the severity of the condition prior to surgery.

  • If you experienced only intermittent episodes of numbness, damage to the nerve is not likely, and the episodes will most likely resolve.
  • If the numbness was constant, then the relief of symptoms will depend on the patient. Most will notice improvement, and for some it will resolve completely. Other patients will not recover normal sensation due to preexisting nerve damage. Improvements may occur for up to 12-18 months after surgery. Even if full sensation does not return, the surgery is likely to prevent symptoms from worsening.

Complications can occur with any surgical procedure. Potential complications related to this procedure include but are not limited to infection, nerve, vessel or tendon injury, persistent pain, persistent numbness, persistent weakness, persistent stiffness, ulnar nerve instability, possible need for additional surgery and reflex sympathetic dystrophy (RSD).