What is this?
The ulna nerve travels from the neck, around the elbow through a tight space (cubital tunnel) into the hand. In the hand the nerve provides sensation to the ring and little fingers and controls most of the little muscles in the hand that help with fine movements. Compression of the ulna nerve at the elbow leads to symptoms of pins and needles, numbness and weakness in the fingers and hand. In most cases there is no obvious cause although people with elbow arthritis or previous elbow trauma are more likely to develop cubital tunnel syndrome.
What are the symptoms?
Most patients report numbness and tingling in the ring and little fingers, which may be worse with the elbow bent and at night. Pain and achiness on the inner side of the forearm may also be present. More severe cases can result in muscle wasting, weakening of the grip and difficulty with finger coordination.
Will I need any further investigations?
Cubital tunnel syndrome can usually be diagnosed on history and examination findings although electrical tests (nerve conduction studies) will be performed to confirm the location and severity of compression.
What are the non-surgical treatment options?
Occasionally very mild symptoms improve spontaneously. Splints that keep the elbow straight at night may help in mild cases but are of little benefit in longstanding cases. Medication and other non-surgical treatments are generally ineffective at reducing symptoms.
What does surgery involve?
This short procedure is carried out under general anaesthetic. A small incision is made on the inside of the elbow and the tight tissue is released to relieve the compression of the nerve within the tunnel. Very occasionally, the nerve is found to flip around to the front of the elbow (subluxing nerve) in which case it may be necessary to move (transpose) the nerve to a pocket of tissue in a more forwards position. The wound is closed with absorbable sutures and a dressing and soft bulky bandage applied.
What is the success of surgery?
Generally, this is a safe and reliable operation to relieve your symptoms. However, it is important to be aware that if the nerve has been badly compressed for a long time, recovery will take longer and occasionally may be incomplete. In this situation surgery should at least prevent the problem from getting worse.
What are the potential risks of surgery?
Any surgical procedure carries risks, however every effort is made to minimise these to ensure the best possible outcome from your surgery. The commonest risks of surgery include infection, bleeding, scar tenderness and failure to fully cure the problem.
What is the recovery after surgery?
You can go home on the same day as the operation. After 2-3 days the bandage can be reduced and you can begin gently moving the elbow with light activity (physiotherapy is not required). Excessive elbow movement should be avoided for the first 2 weeks as the wound is healing. There will be an adhesive dressing over the wound, which can usually be left undisturbed until your follow-up appointment at around 2 weeks. You will be seen in clinic two weeks after surgery to check the wound and assess recovery. There are no sutures to be removed, as they will dissolve under the skin.
When can I return to normal activities?
Return to work depends on the nature of the job. You can return to desk and computer work when you feel comfortable to do so but avoid any manual work, heavy lifting or sporting activities for 4-6 weeks. You may return to driving when you feel safe to control the vehicle, which is usually about 10-14 days after surgery.