Preparing for Cubital Tunnel Surgery: What Is Cubital Tunnel Syndrome and How Do Doctors Treat It?

cubital tunnel surgery

If you’re having pain in your fingers and elbow, it might be the start of a larger problem. A light tingling or numbness, particularly in the ring and little finger may indicate that you have Cubital Tunnel Syndrome.

The sooner you discover or are diagnosed with Cubital Tunnel Syndrome, the better prognosis is for full function of the Ulnar Nerve to return. And the better chances you may not have to get Cubital Tunnel surgery. To learn what Cubital Tunnel Syndrome is and its symptoms, keep reading below.

What is Cubital Tunnel Syndrome?

Cubital Tunnel Syndrome (or Ulnar Nerve Entrapment) is when the ulnar nerve located in the inside of your elbow is injured due to long standing compression, otherwise known as a compressive neuropathy at the elbow. The Ulnar Nerve passes through the Cubital Tunnel.  The tunnel is made if fibrous tissue that does not stretch.  Sometimes that space is narrowed, and causes compression on the nerve.  Even if the Ulnar Nerve isn’t damaged but is irritated, swollen, or inflamed, it can cause Cubital Tunnel Syndrome.

The pain inflicted by Cubital Tunnel Syndrome will feel as if you’ve hit your funny bone. Some might not know this, but when you hit your funny bone, you’re actually hitting the Ulnar Nerve.

This is why that sensation runs through your arm because you’re pinching a nerve that runs from your neck to your fingertips. If you feel as if your funny bone is constantly being hit, then it’s time to see a doctor and get an official diagnosis.

What Causes Cubital Tunnel Syndrome?

The causes of Cubital Tunnel Syndrome can be due to a few things. Doing a lot of heavy lifting is a common cause.

Also, anytime you bend your elbows often, it can lead to Cubital Tunnel Syndrome. Pulling or reaching a lot can put stress on the Ulnar Nerve and cause it to be inflamed or irritated. Even if you find yourself leaning on your elbows a lot, you may be putting unwanted stress on the Ulnar Nerve.

Other things such as bone spurs, arthritis, and previous injuries in the arm such as broken bones or fractures can lead to Cubital Tunnel Syndrome. It’s good to point out that most people don’t know they have this syndrome. If you feel any long-lasting discomfort in your elbow it’s a good idea to schedule an appointment.

How Do I Know If I Have It?

If you’re wondering if you’ve been suffering from Cubital Tunnel Syndrome and are unsure if you have it, it’s a good idea to review the symptoms. We are going to touch base on the most common symptoms of the syndrome, but it’s good to keep in mind that no two bodies are alike and each person may have different symptoms.

If you’re experiencing numbness in your hand or even your ring or pinky finger this may be a sign of the syndrome. If this numbness is triggered by bending, leaning on, or extending your elbow it’s a telltale sign that something is wrong.

Hand pain is another symptom that is common with Cubital Tunnel Syndrome. If you experience random jolts of hand pain often or it’s inflicted by moving your elbow, it’s a sign of Cubital Tunnel Syndrome. In addition, any wrist pain you may feel can also be an indicator that the Ulnar Nerve is pinched or inflamed.

An aching pain on the inside of your elbow is another early symptom of the disease. If you’re sitting with your elbow slightly bent and feel an ache then your Ulnar Nerve may be trying to tell you it’s irritated.

One of the most common symptoms of Cubital Tunnel Syndrome is when your grip becomes weak and you find yourself being more clumsy with the affected arm. If you notice that you can’t grip as tightly as you used to or are dropping things left and right, this is an indication that the nerve isn’t working properly with the rest of your body.

Even though these are common symptoms of Cubital Tunnel Syndrome, they can also be related to other issues with the arm or elbow.

An interesting finding is that your pinky finger may stick out, like you are having tea with the Queen of England. It is called a Wartenburg sign, and occurs because the muscles that keep the pinky straight are weak, and there is unopposed forces from muscles that have nerve fibers from a different nerve (radial nerve) pulling it away from the other fingers. The delicate balance between these muscles is off, like two different people on a teater totter, one heavier than the other.

How Will My Health Care Provider Diagnose Me?

To give you the proper diagnosis of Cubital Tunnel Syndrome, a health care provider will begin by reviewing your past medical history to see if there have been any past injuries to the elbow or arm. From here, they will give you a physical examination to see where the pain manifests, what movements cause the discomfort, and what levels of pain you experience.

After looking you over, the doctor will most likely ask for testing to confirm you have Cubital Tunnel Syndrome. There are three tests you may be asked to do before getting an official diagnosis.

1. Nerve Test

A nerve test (usually known as a nerve conduction study) will measure how fast an electric current or impulse moves through your nerves. When the test is given, the selected nerve will be stimulated with electrode patches attached to your skin.

These patches will be placed directly on your skin over the nerve in question, in this case, it will be an Ulnar Nerve test. Then one of the patches will send an electric impulse through the nerve while the second patch records its findings.

The data recorded is speed. The second patch will calculate the speed by measuring the distance or time between electrodes, looking at how long they take to travel through the nerve specifically. If the time between each impulse is longer than normal it can indicate an issue with the tested nerve.

2. X-Ray

You may be wondering how getting an X-ray will help the doctor to see if you’re nerve is irritated. Well, if you had broken a bone, the doctor can look at the X-ray to see if the bone healed and pinched the nerve in the process.

X-rays will also tell your health care professional if there are bone spurs irritating the Ulnar Nerve. The third thing an X-ray can show is arthritis in the elbow, leading to irritation in the nerves.

3. Electromyogram

An Electromyogram (EMG) is used to record and test electrical activity in the muscles. Even though it’s mainly used for seeing how muscles respond, it can also be used to record electrical activity in nerves.

When you get an EMG for possible Cubital Tunnel Syndrome, the EMG will be testing your forearm muscles that are controlled by the Ulnar Nerve. The way your forearm muscles react to the electric currents will help medical professionals see if the Ulnar Nerve is working properly.

What Are the Treatments For Cubital Tunnel Syndrome?

After your medical professional has diagnosed you with Cubital Tunnel Syndrome, it will be time to look into treatment options. Doctors will tell you to avoid any activity or movements that seem to be causing the pain. This is the most effective way to treat Cubital Tunnel Syndrome by giving the Ulnar Nerve a rest and taking the strain off of it.

You may be required to wear a splint to limit the movement of your arm and elbow. This splint is usually worn at night to reduce irritation that might occur while sleeping. If a splint is too uncomfortable you can ask for a foam elbow brace instead.

Nerve gliding exercises will also be shown to you. These exercises are meant to help the Ulnar Nerve slide through the tunnel, helping to relieve pressure and irritation. Another upside to these exercises is that it will help reduce stiffness in the arm and wrist.

As for medications, you may have to take anti-inflammatory medicines or steroids. Anti-inflammatory medicines can be bought over the counter and help the nerve to be less inflamed, leading to less pain. If this isn’t helping, you may need a few steroid shots to bring down the swelling and pain.

Cubital Tunnel Surgery

If none of these treatments or medications seem to be helping, then the possibility of surgery will be introduced. If the nerve was greatly compressed at the time of diagnosis, then your doctor will most likely jump to the option of surgery immediately.

An Orthopedic Surgeon will be performing the surgery on your Ulnar Nerve. The Orthopedic Surgeon will sit down with you and inform you of different surgery options to relieve the pain, ultimately choosing the best surgery for your condition.

1. Cubital Tunnel Release. – Endoscopic versus Open

The first surgery you will hear about is cubital tunnel release. In this procedure, the roof of the cubital tunnel is divided by a single cut.

This will increase the tunnel’s size and place less pressure on the Ulnar Nerve. After surgery, new growth will heal the cut and allow more space for the Ulnar Nerve to slide through the tunnel.

This surgery is ideal for when the compression of the Ulnar Nerve is moderate or mild. When getting this procedure, you will not have to spend the night at a hospital unless recommended by your doctor.

Studies have shown that an endoscopic in-situ decompression of the ulnar nerve yields as good of results both short and long term as if you were to move the nerve.  We prefer the endoscopic cubital tunnel release for this reason, in addition, it is a minimally invasive cubital tunnel release, which means the incisions are much smaller, less likely to cause pain and scarring, and will heal faster.

2. Ulnar Nerve Anterior Transposition

The next surgery that will be discussed is Ulnar Nerve Anterior Transposition. This procedure consists of moving the Ulnar Nerve from behind the medial epicondyle and placing it in front. This will help the nerve to not get caught on any ridged bones and stretching too much when you extend your elbow.

Your nerve will come to rest right below your skin and fat, on top of the muscle. It can also be placed within the muscle or underneath it.

3. Medial Epicondylectomy

The third surgery that can be performed is a medial epicondylectomy. This is another surgical option to help release the nerve. This procedure will remove a portion of the epicondyle and will help to prevent the Ulnar Nerve from getting caught on any rigid bone.

Preparing for Surgery

Any type of surgery can be a nerve-wracking experience, but we want to provide you with a few tips before your procedure to take some of the stress away. Any of the 3 procedures listed above will be performed under general anesthesia.

With this said, you shouldn’t take any medications that thin blood within a week before surgery. You will not be allowed to drink or eat anything after midnight the night before surgery. It’s also important that you set up plans with a friend or family member to pick you up after surgery and handle all discharge papers.

Recovery After Surgery

After undergoing any of the procedures listed above, you will be required to wear a splint for a few weeks. After a few visits with your surgeon to see how your arm is healing, they will take the split off and recommend physical therapy. Physical therapy will help you regain strength in your arm and also help with movement after the surgery.

Usually, dressings are needed for 10-14 days after surgery. Any stitches (if any are applied) should dissolve on their own and need no removal from your surgeon. Keep in mind that it’s important to change your dressings as needed to keep them clean and to also not get your incision wet for up to 5 days after the procedure.

There is a high success rate to these procedures and they leave most patients without pain. The recovery time for each procedure varies and depends on the individual patient and the healing process.

We Wish You the Best With Your Cubital Tunnel Syndrome

From knowing the telltale signs of Cubital Tunnel Syndrome, to being aware of treatments, and even being prepared for Cubital Tunnel surgery, you should be well informed of the condition. If you feel as if you’re showing any of the signs of Cubital Tunnel Syndrome, make sure to contact your medical professional right away.

The earlier you catch the irritation of the Ulnar Nerve, the less severe it will be. This means you may not even have to schedule surgery if you take care of your arm and Ulnar Nerve.

For more information on hand health, be sure to contact us.

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