Cubital Tunnel Surgery
Cubital tunnel syndrome, also called ulnar nerve entrapment, is a condition caused by compression of the ulnar nerve in an area of the elbow called the cubital tunnel. The ulnar nerve travels down the back of the elbow behind the bony bump called the medial epicondyle to enter the cubital tunnel. The cubital tunnel is a narrow passageway on the inside of the elbow formed by bone, muscle and ligaments with the ulnar nerve passing through its center. The roof of the cubital tunnel is covered with soft tissue called fascia. When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump. When the ulnar nerve is compressed or entrapped, the nerve can tear and become inflamed, leading to various symptoms.
Signs and symptoms of cubital tunnel syndrome usually occur gradually, progressing to the point where the patient seeks medical attention. Left untreated, cubital tunnel syndrome can lead to permanent nerve damage in the hand.
Your physician will initially recommend conservative treatment options to treat the cubital tunnel syndrome symptoms unless muscle wasting or nerve damage is present. Conservative treatment options may include wearing a brace or splint at night while sleeping to keep the elbow in a straight position. You can also wrap the arm loosely with a towel and apply tape to hold it in place.
If conservative treatment options fail to resolve the condition or if muscle wasting or severe nerve compression is present, your surgeon may recommend a surgical procedure to treat cubital tunnel syndrome.
Surgeries performed to treat cubital tunnel syndrome include:
- Medial epicondylectomy
- Ulnar nerve transposition
If your nerve compression is mild, your surgeon may recommend a medial epicondylectomy. In this procedure, your surgeon will make an incision over the medial epicondyle, the bony bump on the inside of the elbow. The cubital tunnel is cut open through the soft tissue roof, exposing the ulnar nerve. The forearm muscles or flexor muscles are cut and detached from the epicondyle. Using special instruments, your surgeon will shave away the bump, freeing the ulnar nerve to glide smoothly within the cubital tunnel without pressure from the bump. The flexor muscles are then reattached to the area of shaved bone with special sutures. The incision is then closed with sutures and covered with a dressing.
Ulnar nerve transposition
More commonly, your surgeon may recommend an ulnar nerve transposition. Your surgeon will make an incision over the medial epicondyle. The cubital tunnel is cut open through the soft tissue roof, exposing the ulnar nerve. The forearm muscles or flexor muscles are cut and detached from the epicondyle. The ulnar nerve is transposed or moved from behind the elbow to a new location in front of the elbow. The ulnar nerve may be placed above the flexor muscle, within the muscle, or under the muscle. Your surgeon will decide which option is best for you. The flexor muscles are then sutured back together and reattached with special sutures to the epicondyle. The incision is then closed with sutures and covered with a dressing.
What are the risks and complications of cubital tunnel syndrome surgery?
As with most surgical procedures cubital tunnel surgery may be associated with potential complications such as:
- Nerve damage causing permanent areas of numbness around the elbow or forearm
- Elbow instability
- Elbow flexion contracture
- Pain at site of scar
- Symptoms not improved by the surgery