Cubital tunnel syndrome affects approximately 5.9% of the general population, according to Orthopedic Reviews. It’s the second most common peripheral nerve compression syndrome after carpal tunnel syndrome. The condition arises from ulnar nerve compression at the elbow, leading to symptoms like numbness, tingling, and hand weakness.
When conservative treatments fail, surgery for cubital tunnel syndrome becomes a viable option to alleviate discomfort and restore functionality. Let’s look into the surgical aspects of cubital tunnel syndrome, exploring when surgery is necessary, the types of procedures available, potential risks, and post-surgery recovery tips.
Understanding Cubital Tunnel Syndrome
Cubital tunnel syndrome happens when the ulnar nerve is compressed at the elbow, leading to discomfort, numbness, and weakness in the hand. This condition affects many people, particularly those who frequently bend their elbows or rest them on hard surfaces for long periods. While mild cases may improve with rest and physical therapy, more severe cases can interfere with daily activities.
There are three primary reasons why cubital tunnel syndrome develops:
- Repetitive elbow movement
- Prolonged pressure on the elbow
- Past injuries or structural issues
Repetitive Elbow Movement
Frequent bending and extending of the elbow can stretch the ulnar nerve. Jobs or hobbies that require repeated arm motions, such as using tools, playing musical instruments, or typing, may contribute to this condition. The more the nerve is stretched, the higher the risk of inflammation and irritation.
Prolonged Pressure on the Elbow
Resting the elbow on a firm surface for long periods can increase pressure on the ulnar nerve. The pressure can slow down nerve signals, leading to numbness and tingling in the hand. People who sleep with their arms bent or lean their elbows on desks and armrests for extended periods are more likely to develop symptoms.
Past Injuries or Structural Issues
A previous fracture, dislocation, or arthritis in the elbow can change the way the ulnar nerve moves. In some cases, the nerve may shift out of place, making it more prone to irritation. People with naturally tight or narrow cubital tunnels may also be at greater risk.
When Is Surgery Needed for Cubital Tunnel Syndrome?
Cubital tunnel syndrome can often be managed with bracing, physical therapy, and lifestyle changes. But when symptoms persist or worsen, surgery may be the next step. Doctors determine the need for surgery based on the severity of nerve compression and how much it affects daily activities.
There are three main signs that surgery for cubital tunnel syndrome may be necessary:
- Symptoms do not improve with non-surgical treatments
- Muscle weakness or loss of hand function
- Nerve damage is confirmed through medical tests
Symptoms Do Not Improve with Non-Surgical Treatments
Doctors usually start with conservative treatments to relieve ulnar nerve compression. A splint or brace can keep the elbow in a more natural position, reducing pressure on the nerve.
Adjusting work habits, such as avoiding prolonged elbow flexion, may help. Some patients benefit from physical therapy to strengthen muscles around the nerve. When these methods fail to provide lasting relief, surgery for cubital tunnel syndrome becomes an option.
Muscle Weakness or Loss of Hand Function
Early symptoms often include numbness or tingling in the ring and pinky fingers. Over time, severe nerve compression can weaken the muscles in the hand, making everyday tasks harder.
Patients may notice grip strength decreasing or struggle to perform fine motor activities. If weakness progresses, doctors may recommend surgery to prevent further loss of function.
Nerve Damage Is Confirmed Through Medical Tests
If symptoms are long-lasting or severe, doctors may order nerve conduction studies and electromyography (EMG). These tests measure how well the ulnar nerve transmits signals.
A significant delay or blockage in these signals can confirm nerve compression. If damage is detected, delaying treatment could lead to permanent nerve impairment, making surgery a necessary step.
Surgery is not always required for cubital tunnel syndrome, but it may be the best option when non-surgical treatments fail, hand weakness develops, or medical tests show nerve damage. Doctors weigh these factors carefully before recommending a procedure.
Cubital Tunnel Syndrome Treatment: Types of Surgery
When non-surgical treatments fail to relieve symptoms, surgery for cubital tunnel syndrome may be the best option. The goal is to reduce nerve compression and prevent further damage. The right procedure depends on the severity of the condition and the patient’s anatomy. There are three main types of surgery used to treat this condition:
- Nerve decompression
- Ulnar nerve transposition
- Medial epicondylectomy
Nerve Decompression
Nerve decompression, also called simple decompression, is the least invasive option. The surgeon makes a small incision near the elbow and carefully removes the tissue pressing on the ulnar nerve.
The procedure is often effective for patients whose nerve remains stable in its normal position. Since the nerve is not moved, the surgery is quicker, and recovery is often faster. This method is typically recommended when the nerve compression is mild to moderate.
Ulnar Nerve Transposition
In some cases, the ulnar nerve shifts out of place or gets irritated by movement. Ulnar nerve transposition involves repositioning the nerve to reduce irritation. The surgeon moves the ulnar nerve from behind the medial epicondyle to a new location in front of the elbow.
The procedure prevents the nerve from stretching when the elbow bends. It is often recommended for patients whose nerve moves excessively or has severe compression. While this method can provide long-term nerve compression relief, recovery may take longer than with a simple nerve decompression.
Medial Epicondylectomy
Medial epicondylectomy removes a small portion of the medial epicondyle, the bony structure on the inner side of the elbow. By removing part of this bone, the surgeon creates more space for the ulnar nerve, reducing compression. Unlike ulnar nerve transposition, the nerve remains in its normal position.
The procedure is usually performed when the nerve compression is caused by the bone structure itself. It can be a good option for patients who need nerve decompression without moving the nerve.
The Surgical Procedure: What to Expect
Surgery for cubital tunnel syndrome is usually performed on an outpatient basis, meaning most patients go home the same day. The exact procedure depends on whether the surgeon chooses nerve decompression, ulnar nerve transposition, or medial epicondylectomy.
Each of these methods aims to relieve nerve compression and prevent further damage. Before the procedure, patients undergo a medical evaluation to ensure they are healthy enough for surgery.
There are three main stages of the procedure:
- Pre-surgery preparations
- The surgical process
- Immediate post-surgery care
Pre-Surgery Preparations
Before surgery, the doctor will review the patient’s medical history and may order tests to check for any underlying conditions that could affect recovery.
Patients are usually advised to stop taking certain medications that may increase bleeding risk. Since most procedures require local, regional, or general anesthesia, patients will need to avoid eating or drinking for several hours before surgery. The doctor will also explain what to expect after the procedure, including pain management and movement restrictions.
The Surgical Process
The surgeon begins by making an incision along the inside of the elbow. The size of the incision depends on the type of procedure being performed.
If a simple decompression is chosen, the surgeon will remove tissue pressing on the ulnar nerve, allowing it to move freely. If an ulnar nerve transposition is needed, the nerve will be carefully relocated to a new position to prevent further irritation.
In cases where medial epicondylectomy is required, a small part of the medial epicondyle is removed to create space for the nerve. The surgeon then closes the incision with sutures or surgical tape.
Immediate Post-Surgery Care
After the procedure, patients are monitored in a recovery area while the anesthesia wears off. The arm is usually placed in a soft bandage or splint to keep it stable and protect the incision.
Some patients may experience temporary numbness, swelling, or discomfort, which can be managed with prescribed pain medication. Most people are discharged the same day with instructions on caring for the surgical site, managing discomfort, and when to schedule a follow-up appointment.
Risks and Potential Complications
Surgery for cubital tunnel syndrome is generally safe, but like any medical procedure, it carries some risks. Most patients recover well with minimal issues, but there are potential complications to be aware of.
These can vary based on the type of procedure performed, individual health factors, and how well post-surgery instructions are followed.
The main risks include:
- Infection
- Nerve damage
- Scar tissue formation
Infection
Any surgical procedure carries a small risk of infection. After surgery, the incision site is covered with a bandage to protect it, but bacteria can still enter if the wound is not properly cared for.
Signs of infection include redness, swelling, warmth, or discharge from the incision. In some cases, a fever may develop. Mild infections can often be treated with antibiotics, but severe infections may require further medical attention.
Nerve Damage
Since the ulnar nerve is already under stress, any surgical manipulation carries a slight risk of additional damage. While most patients experience relief from nerve compression, some may notice lingering numbness, tingling, or weakness after the procedure.
This can happen if the nerve is stretched or irritated during surgery. In rare cases, nerve function does not fully return, leading to long-term changes in sensation or movement.
Scar Tissue Formation
After surgery, scar tissue may form around the ulnar nerve or the surgical site. If too much scar tissue develops, it can restrict movement and cause discomfort.
Some patients may feel stiffness in the elbow or notice a pulling sensation near the incision. Physical therapy and stretching exercises can help minimize stiffness and improve mobility.
Most patients recover without serious complications, but it is important to follow all post-surgery recovery tips to reduce risks. Keeping the incision clean, avoiding excessive arm movement, and attending follow-up appointments can improve the outcome.
If any unusual symptoms develop, such as severe pain, worsening numbness, or signs of infection, it is best to contact a doctor right away.
Post-Surgery Recovery Tips and Timeline
Right after surgery, the elbow is usually wrapped in a bandage or placed in a splint to keep it stable. Patients may experience swelling, soreness, and stiffness, but these symptoms should improve within a few days.
Pain medication is often prescribed, though some people manage with over-the-counter options. Keeping the arm elevated and using ice packs as recommended can help reduce swelling.
Most patients can move their fingers and wrist soon after surgery, but elbow movement may be limited at first. Depending on the procedure, some people wear a splint or brace for a few weeks to protect the ulnar nerve as it heals. Stitches are typically removed within 10 to 14 days, though dissolvable stitches may not require removal.
Rehabilitation and Physical Therapy
Once the incision heals, gentle stretching exercises help prevent stiffness in the elbow, wrist, and fingers. A physical therapist may provide a set of exercises to improve mobility and strengthen muscles.
Patients recovering from ulnar nerve transposition or medial epicondylectomy may need more structured therapy since these procedures involve changes to the nerve’s position or surrounding bone.
Hand weakness and grip strength issues can take longer to resolve. Strength-building exercises, such as squeezing a soft ball or using resistance bands, can help improve function. Most people regain normal movement within a few weeks, but full nerve recovery can take longer.
Surgery for Cubital Tunnel Syndrome
Surgery for cubital tunnel syndrome helps relieve nerve compression and improve hand function for many patients. Recovery takes time, but most regain strength and movement with proper care. Early treatment leads to better outcomes, and post-surgery therapy plays a key role in long-term success. Follow-up care ensures lasting relief and healing.
We are Houston’s trusted specialists for hand, wrist, and elbow care, offering advanced, minimally invasive treatments. At Hand Surgery Specialists of Texas, our expert hand and finger surgeons provide top-tier care at locations in River Oaks, Webster, North Houston, Katy/Sugarland, and Baytown. Whether you need a diagnosis or treatment, we are here to help you regain comfort and function with the latest surgical and non-surgical techniques.
Get in touch today to find out how we can help with your cubital tunnel syndrome!
