Cubital tunnel syndrome
Cubital tunnel syndrome is a condition that affects one of the main nerves of the upper limb (ulnar nerve) as it travels around the elbow in a passageway called the cubital tunnel. In this tunnel the nerve can be compressed or stretched, leading to problems with how the nerve functions. The cause of this is largely unknown, but can occur due to swelling of tendons, joint problems, arthritis.
The ulnar nerve supplies feeling to the little finger and half of the ring finger, and also supplies many muscles in the forearm and hand. People with cubital tunnel may therefore present with weakness or numbness of the hand, mainly affecting the ring and little finger. Symptoms are often worse with elbow bending.
Not all patients with signs or symptoms of cubital tunnel syndrome will require surgery. Dr Colbert will assess the severity of your cubital tunnel syndrome by taking a detailed history, performing an examination of the nerve, and sometimes sending you for a nerve conduction test.
People with mild cubital tunnel syndrome may have intermittent symptoms, being more common at night or when the elbow is bent for long periods. Often mild cubital tunnel is treated with non-surgical measures, such as elbow splints and avoiding movements that stretch the nerve.
People with more severe cubital tunnel syndrome may have more severe symptoms. You may have noticed a weaker grip, or clumsiness when using your hand. Sensation to your little finger finger may be reduced, and some of the muscles in your hand may have reduced in size. An operation to release the cubital tunnel ( a cubital tunnel release) is required to reduce the pressure on the nerve.
Cubital tunnel release is usually performed under general anaesthesia (with you asleep), with local anaesthesia also injected to ensure you are comfortable after the operation.
A surgical tourniquet is placed on the upper part of your arm, and an incision is made over the cubital tunnel, which is located on the inside of your elbow. The roof if the cubital tunnel is released to help reduce the pressure on the ulnar nerve, as are any other points of compression that are seen during the procedure. In some instances the location of the nerve can be changed so it lies in front of the elbow, but this is not routinely required. The incision is closed with dissolvable sutures, and a comfortable dressing is applied. Cubital tunnel surgery is performed as outpatient surgery, meaning you don’t need to stay in hospital overnight.
Return to your usual daily activities after a cubital tunnel release will follow a gradual process, coordinated by Dr Colbert and a specialised hand therapist.
Immediately after surgery you are encouraged to use your hand to complete light duties (e.g. dressing, making meals). It is important to move your elbow and shoulder within the limits of any pain to help reduce the risk of any stiffness.
Excessive weight bearing through the arm (e.g. lifting pushing up from a chair, or heavy gripping) should be avoided for the initial four weeks.
Cubital tunnel release is performed through a short scar on the inside of the elbow. In most cases this scar will measure approximately four centimetres, but depending on findings may sometimes be a few centimetres longer.
Cubital tunnel syndrome is associated with the following risks:
Scarring: this may be lumpy, thick, or tender.
Bleeding or haematoma: this means a collection of blood that requires a return to the operating theatre to remove.
Infection: if wounds become red or tender they may need a course of antibiotics.
Nerve damage: the ulnar nerve, or some of its smaller branches may very rarely be damaged, resulting in temporary or permanent pins and needles or weakness.
Incomplete recovery: nerves recover slowly, and it may take a long time to know how well the nerve will recover after surgery. In some cases the nerve may be so compressed that it wont recover completely, despite the nerve being completely released of any pressure.
Cubital tunnel decompression, like any surgical procedure, carries risks and therefore before proceeding you should always seek an opinion from an appropriately qualified health practitioner.