Everything You Need to Know About Cubital Tunnel Endoscopic Surgery

Cubital tunnel

Did you know that cubital tunnel syndrome is the second most common peripheral nerve entrapment syndrome? If you’re suffering from intense elbow pain, difficulty with range of motion, numbness or tingling of the ring and little fingers, weakness with gripping,  you aren’t alone. You could be suffering from cubital tunnel syndrome.

If you have cubital tunnel syndrome, you may find relief with cubital tunnel endoscopic surgery. This cubital tunnel syndrome treatment can help relieve symptoms while getting you back to the things you enjoy.

To learn more about cubital tunnel syndrome surgery, keep reading. It could be the thing that you need to ease your pain.

What Happens in Cubital Tunnel Syndrome?

In order to understand cubital tunnel endoscopic surgery, you have to understand a little bit about the anatomy and physiology behind the ulnar nerve and the cubital tunnel.   The ulnar nerve can get trapped or pinched or compressed by certain fibrous bands or ligaments.  There are several known points of compression, that surgeons address when they perform an ulnar nerve decompression.

The ulnar nerve passes from the anterior (front) compartment of the brachium to the posterior (back) compartment of the brachium. In doing this, it passes through a structure called the arcade of Struthers.

Because of its bands of brachial fascia, the arcade of Struthers is notorious for entrapping the ulnar nerve. This is the most common culprit of ulnar nerve compression.

Alternatively, further distal into the forearm,  the ulnar nerve may become compressed by the intermuscular septum. This is a muscular structure that covers the ulnar nerve as it passes down the forearm into the hand. However, this is less common.

The real problem starts happening when the entrapment causes cubital tunnel syndrome. Once the ulnar nerve reaches the medial epicondyle, it passes through a fibrous space known as the the cubital tunnel. Then, it goes deeper into the body through multiple muscle layers.

The distal (far) release of the ulnar nerve is the most important part of the surgical procedure for cubital tunnel syndrome. This involves taking the pressure off the ulnar nerve through the tunnel and muscle layers.

What Is Cubital Tunnel Endoscopic Surgery?

Even though cubital tunnel syndrome is the second most common nerve entrapment condition, there is no standard treatment for the problem. Luckily, a endoscopic release surgery has shown promise in these patients.  Whether open or endoscopic, the goal is to take the pressure off of the nerve.  Studies have shown, leaving the nerve where it belongs (commonly refered to as an in-situ decompression of the ulnar nerve) versus moving the nerve to a above the medial epicondyle (submuscular or subcutaneous transposition of the ulnar nerve) yield the same amount of benefit in terms of nerve recovery.

Cubital tunnel endoscopic surgery is also known as the endoscopic cubital tunnel release procedure. You may also see this noted as ECuTR.

ECuTR is a minimally-invasive surgical technique that decompresses the ulnar nerve at the point at which it passes through the cubital tunnel. This tunnel is located inside of your elbow.

The ulnar nerve supplies sensation to your ring and pinky fingers as well as the inner side of your forearms and hands. It also innervates a lot of the muscles that we have in our hands. So, good ulnar nerve function is essential for us to perform fine motor skills and gripping motions.

If you’re experiencing compression of the ulnar nerve due to cubital tunnel syndrome, you may have symptoms like weakness, numbness, and tingling in these areas.

Your surgeon may opt for you to get cubital tunnel release surgery if you fall into one of these two categories:

  1. You have a severe case of ulnar nerve entrapment that doesn’t respond to pharmacological therapies such as anti-inflammatory pills and steroid shots
  2. You have a case of ulnar nerve pinching that has caused serious muscle weakness and damage

If you feel that you would benefit from this cubital tunnel syndrome treatment, talk to your physician about scheduling an appointment. The procedure could be life-changing.

Who Can Get Cubital Tunnel Endoscopic Surgery?

The most common indication for endoscopic cubital tunnel surgery is idiopathic cubital tunnel syndrome. The term ‘idiopathic’ means that there is no known cause of the syndrome.

Usually, the patients that need this kind of surgery have already tried and failed conservative treatments. They may have made ergonomic life changes. They have tried medications, procedures, and treatments.

Before opting for surgery, your physician may want to try a few more drastic measures, such as nighttime splinting, nerve glide exercises, and activity restraint. If you can tolerate your condition with these changes, you can continue to use conservative treatment.

However, if you’re having a great deal of pain, your physician may offer an endoscopic cubital tunnel release surgery.

Who Shouldn’t Get Cubital Tunnel Endoscopic Surgery?

Since this cubital tunnel syndrome treatment involves surgical intervention, there are a few contraindications for it. These are reasons that you shouldn’t get the endoscopic surgery done:

  • You have a mass or another space-occupying lesion of any kind
  • You have a history of elbow contractures that require release
  • You have a history of a medical condition that requires anterior transposition
  • You had prior surgery or trauma that caused scarring or adherence of the ulnar nerve

If any of these statements apply to you, you should talk to your physician about resolving the prior issues (if possible) before moving forward with endoscopic surgery. Otherwise, the surgery may cause more harm than good.

Some physicians also suggest against giving surgical treatment to patients with subluxated ulnar nerves and/or ulnar neuritis. They don’t fair well with the surgery unless their symptoms occur predominantly in the hand.

Lastly, surgery is not recommended for patients with medial epicondylitis, especially those who have had a concomitant medial epicondylectomy.

How Can I Prepare for Endoscope Cubital Tunnel Surgery?

First, you have to have a thorough exam from your surgeon. They’re going to check for any medical issues that you may need to resolve prior to getting surgery.

Depending on your medical history, your physician may want to run certain blood tests or imaging tests to detect any abnormalities that may threaten your safety during the procedure.

They’ll also ask if you have any allergies to certain medications, anesthesia, or latex.

You should bring a list of all of your current medications, vitamins, and supplements. Your physician will be able to tell a lot about you and your health based on this list.

They may also have you stop taking some of these medications a couple of weeks before the surgery. Usually, surgeons will ask their patients to stop taking blood thinners and anti-inflammatory medications temporarily, so that there isn’t too much blood loss during surgery.

You may also have to stop using alcohol and tobacco before the surgery.

Within the eight hours before your surgery, you’ll have to stop ingesting both solids and liquids. You should be on an empty stomach when you go in to have the surgery done.

Lastly, you should arrange for someone to drive you home after the surgery is complete. You shouldn’t have plans to do anything else that day other than rest and recover.

How Is Cubital Tunnel Syndrome Surgery Performed?

First, the surgeon is going to find a bony protrusion on the inside of your elbow. The cubital tunnel lies behind this bony bump.

To get behind this bone, the surgeon will make an incision of about 2 centimeters towards the back of it. This will allow the surgeon to approach the ulnar nerve at the point in which it’s in the cubital tunnel.

Then, the surgeon will place retractors into the incision to pull back all of the other nerves. This will help the surgeon focus on the ulnar nerve alone without hurting any other parts.

Once this is done, the surgeon can insert an endoscope. This is a long, thin tube that allows the surgeon to see via a camera on the end. They can use it to see the ulnar nerve and the structures around it.

To relieve the pressure on the ulnar nerve, the surgeon will make an incision in the roof of the cubital tunnel.

After the surgeon has decompressed the nerve, they’re going to move the elbow in all different positions to ensure that the ulnar nerve is still stable within the elbow. If the nerve does remain stable, the surgery will end the procedure and close using stitches.

If the nerve is not stable, the surgeon will need to make further adjustments to ensure that the patient will have use of their arm.

After the surgery, the arm will be encased in a soft dressing which comes off after about four days.

How Successful Is Cubital Tunnel Endoscopic Surgery?

Cubital tunnel syndrome surgery has great outcomes.

Your outcome will likely vary from good to excellent, as surgery success ranges from 86% to 98%.

What Are the Benefits of Getting Endoscopic Surgery for Cubital Tunnel Syndrome?

The endoscopic approach helps the surgeon get a better look at the ulnar nerve from above and below the elbow. That’s what the camera on the endoscope is for.

With the use of this camera and retractors, the endoscopic technique greatly reduces the risk of nerve damage during the procedure.

Plus, since the surgery is minimally invasive, the recovery time is much faster. And, there is minimal scar tissue formation, leading to less pain after surgery.

Overall, this endoscopic surgery comes with fewer risks and a higher patient satisfaction rate.

What Are the Risks of Cubital Tunnel Syndrome Surgery?

The surgery for cubital tunnel syndrome is serious. It’s a surgery, not a simple everyday procedure.

So, there are going to be a few risks involved. You should expect some symptoms following the surgery as well as some adjustments.

These are the most common symptoms following ECuTR:

  • Pain
  • Numbness
  • Swelling

Severe complications are rare, and most complications occur due to improperly performed techniques on the surgeon’s part. Here are some of the reported complications from past literature about the procedure:

  • Damage to the main branch of the ulnar nerve
  • Infection
  • Collection of blood outside of the blood vessels
  • Dislocation of the nerve

Again, these more serious problems are rare. It is improbable that you’ll experience these complications. However, you should talk to your physician about their experience performing the technique if you’re feeling uneasy about the procedure.

How Soon Does Your Hand Regain Function After Cubital Tunnel Surgery?

Your physician may place you on strict measures when it comes to healing after surgery.

While the exact amount of time will vary from patient to patient, most cubital tunnel patients return to work within eight days after surgery.

However, they may gain full function between four and six weeks after surgery.

If you’d like a closer estimation for your case, ask your physician what they would expect. Keep in mind that they won’t be able to give an exact timeline until they see how your body reacts to the surgery.

Which Is Better: Endoscopic or Open Cubital Tunnel Release?

If you’re thinking about getting surgical treatment for your cubital tunnel syndrome, it’s likely that your physician presented you with two options: endoscopic cubital tunnel release and open cubital tunnel release.

Now, you’ve got to decide which one is best for you.

Endoscopic surgery for cubital tunnel syndrome has been around since the 1990s. It gives patients similar outcomes as the open cubital tunnel release while having a minimally invasive approach.

Endoscopic surgery offers a smaller incision size that gives the staff a better view of the entire ulnar nerve proximally and distally. So, it also reduces the risk of nerve damage as a result of the surgery.

Open surgery is a better option in comparison to classic techniques, such a transposition and an epicondylectomy. And, it may be a great choice for patients who have a more severe case of cubital tunnel syndrome.

However, endoscopic surgery is the better choice between endoscopic and open surgery.

For physicians, the surgical technique has a short learning curve. So, they should be able to learn to technique quickly.

Plus, it only requires the special use of an endoscope. No other specialty instruments are required.

Talk to a Surgeon About Cubital Tunnel Syndrome Treatment

Whew! That was a lot of information, but you made it!

You know all there is to know about cubital tunnel endoscopic surgery.

If you’re interested in cubital tunnel syndrome surgery, you should meet with one of our physicians at Hand Surgery Specialists of Texas. We’d love to help you decide whether cubital tunnel endoscopic surgery is the right choice for you.

To get started, go ahead and schedule an appointment online. We have multiple locations throughout Houston and the greater Houston area.

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