CUBITAL TUNNEL RELEASE

What’s a Cubital Tunnel Release?

The medical term “Cubital Tunnel Release” or “Ulnar Nerve Entrapment” refers to a type of surgery that helps to treat a painful condition named Cubital Tunnel Syndrome (Smeraglia, Del Buono, & Maffulli, 2015). Cubital Tunnel Syndrome refers to an injury that occurs due to the compression of the ulnar nerve in an area of the elbow. This medical condition causes moderate-to-severe pain and numbness in the elbow and ring & little fingers. While left untreated, this condition causes extreme pain and muscle loss in the hand. The squeezing or entrapping of the ulnar nerve results in tears and inflammation of the nerve which leads to cubital tunnel syndrome, causing a range of symptoms.

The ulnar nerve runs down the back of the elbow, below the bony hump known as the medial epicondyle, and through the cubital tunnel. The cubital tunnel usually forms by bone, muscle, and ligaments on the inside of the elbow and passes the ulnar nerve through the center. Fascia, a soft tissue, usually covers the roof of the cubital tunnel. The ulnar nerve can extend and catch on the bony hump when bending the elbow. Therefore, cubital tunnel release involves decompression of the ulnar nerve and, in some cases, nerve transposition (Seradge & Owen, 1998).

Risks of a Cubital Tunnel Release

The majority of patients have no issues after cubital tunnel release surgery, but complications after elbow surgery can include excessive bleeding, risk of infection, swelling of the incision area, fixation failure, temporary or permanent nerve or blood vessel damage, recurrent instability, loss of function, complications from anesthesia, etc. (Nakashian, Ireland, & Kane, 2020).

How Should a Patient Prepare for a Cubital Tunnel Release?

Patients need to consult with their neurosurgeon for a brief medical examination prior to surgery. This medical examination helps to identify any medical issues, such as a urinary tract infection, high blood pressure, or heart disease of patients before the operation. Neurosurgeons suggest you stop taking blood-thinners and arthritis medications such as aspirin, warfarin, naproxen, Motrin, etc. prior to the surgery. Neurosurgeons advise patients not to wear dentures and contact lenses in the operation room. Also, neurosurgeons suggest that patients avoid smoking and consuming alcohol before and after the operation.

How Does a Spinal Surgeon Perform a Cubital Tunnel Release?

Neurosurgeons consider this surgical option when other nonsurgical methods fail or prove ineffective in reducing compression. Therefore, this surgical procedure involves a type of nerve “decompression” or pressure reduction. Neurosurgeons usually perform 2 techniques, such as decompression and transposition, to solve the problem (Boone, Gelberman, & Calfee, 2015). Regardless of the method used, patients can leave the hospital within a day.

1.     The Decompression method

• Neurosurgeons make a 4–5 inch long incision centered at the elbow. 
• Neurosurgeons will make the incision in the back of the elbow along the ulnar nerve’s path, beginning above the intermuscular, traveling anterior to the elbow, and ending above the flexor carpi ulnaris muscle.
• Later, neurosurgeons will cut the arcuate ligament to release the ulnar nerve at the intermuscular septum.
• Finally, neurosurgeons will close the incision with a stitch.

2.     The Transposition method

• Here, the neurosurgeon will fully decompress the ulnar nerve, as in the above procedure. 
• This procedure includes entirely removing the nerve from its groove and positioning it in front of the elbow in a new resting site.
• With a simple decompression, this requires a little larger incision and reduces the chance of nerve instability.
• Patients usually find relief from numbness shortly after surgery, but the nerve may take months to fully restore function, depending on the degree of irritation previous to surgery.

How Long Does a Cubital Tunnel Release Typically Take?

Neurosurgeons usually perform most cubital tunnel release surgeries on an outpatient basis. Neurosurgeons can administer general anesthesia to put a patient completely under, or local anesthesia to only numb the arms or hand of the patient. The surgery usually takes less than one hour to perform.

What is Expected from a Cubital Tunnel Release Recovery?

Patients will arrive at the recovery room after the surgery to receive pain medications for comfort. Nurses will monitor patients in the recovery room until they completely recover from anesthesia. Also, the patient’s arm will remain in a splint until their first postoperative visit a week or two after the operation. Neurosurgeons suggest patients keep their arm dry and avoid heavy lifting until after their post-operative appointment with a neurosurgeon. Neurosurgeons advise patients to avoid bathing or submerging their elbow into water for at least 4 weeks after surgery (Takamoto & Ozyurekoglu, 2020).

Most patients require pain medication for the first couple of days after surgery. Patients should watch for infections or swelling of the operative area during the first week after surgery. During post-operative appointments, the neurosurgeon will remove the bandages and advise the patient to resume their activity slowly at home. Patients can typically drive their car after 4 to 6 weeks of recovery. For more information, please contact us anytime.

References

Boone, S., Gelberman, R. H., & Calfee, R. P. (2015). The Management of Cubital Tunnel Syndrome. Journal of Hand Surgery, 40(9), 1897–1904. https://doi.org/10.1016/j.jhsa.2015.03.011

Nakashian, M. N., Ireland, D., & Kane, P. M. (2020). Cubital Tunnel Syndrome: Current Concepts. Current Reviews in Musculoskeletal Medicine, 13(4), 520–524. https://doi.org/10.1007/s12178-020-09650-y

Seradge, H., & Owen, W. (1998). Cubital tunnel release with medial epicondylectomy factors influencing the outcome. Journal of Hand Surgery, 23(3), 483–491. https://doi.org/10.1016/S0363-5023(05)80466-6

Smeraglia, F., Del Buono, A., & Maffulli, N. (2015). Endoscopic cubital tunnel release: A systematic review. British Medical Bulletin, 116(1), 155–163. https://doi.org/10.1093/bmb/ldv049

Takamoto, K., & Ozyurekoglu, T. (2020). Symptom Recurrence After Endoscopic Cubital Tunnel Release. Journal of Hand Surgery Global Online, 2(3), 129–132. https://doi.org/10.1016/j.jhsg.2020.03.006