Cubital tunnel release surgery: what to expect

Cubital tunnel release is a surgical procedure done to relieve pressure on a trapped nerve (known as the ulnar nerve) on the inside of the elbow. This is the nerve that can cause an uncomfortable tingling sensation if you accidentally hit your elbow on something and is often referred to as "your funny bone".

If the ulnar nerve is compressed and becomes significantly inflamed and damaged over time, it may need to be treated with an outpatient surgical procedure known as cubital tunnel release. Here, one of our top orthopaedic surgeons Mr Phil Wright explains everything that you need to know about the surgery.

 

What happens during cubital tunnel release?

Cubital tunnel release can be performed either under a general anaesthetic or regional anaesthetic. Under a general anaesthetic, the patient is asleep during the procedure and towards the end, a local anaesthetic is injected around the wound to numb the area for approximately six hours.

A regional anaesthetic involves using an ultrasound machine to inject local anaesthetic around the nerves at the top of the arm. The means that the whole arm is numb during the procedure and for around 12 hours afterwards. Your surgeon and anaesthetist will discuss the most appropriate technique for you.

During cubital tunnel release, a 7cm incision is made on the inside of the elbow. The trapped nerve is identified and tissue overlying it is released. The nerve is inspected to determine if there is evidence of scarring around the nerve or swelling within it. In some cases, where the nerve has a tendency to flick forwards as the elbow bends, a decision is made to move (transpose) the nerve from behind the bony prominence on the inside of the elbow (epicondyle) to the front.

The wound is stitched with dissolving stitches and dressings and a soft bandage are applied. The patient can go home the same day as surgery and painkilling tablets can be taken for any mild discomfort.
 

What are the benefits of this procedure?

Cubital tunnel release is done to alleviate the sensation of 'pins and needles' affecting the little and ring fingers. This can be particularly troublesome when the elbow is bent, stretching the “funny bone” nerve. Often, tingling in the fingers occurs at night, when the elbow bends and can disturb sleep.

In some patients, pressure on the nerve can cause weakness in the hand and difficulty with grip strength. Some patients may notice the loss of muscle bulk in the hand. This indicates that there is severe pressure on the nerve and, if left untreated, weakness may be permanent.
 

Are there any reasons a patient wouldn’t be able to have cubital tunnel release?

As untreated cubital tunnel syndrome has potential implications for hand function, there are few reasons why an individual would be unsuitable for surgery. For very frail patients or those with significant medical problems, the risks of an anaesthetic may outweigh the benefits of cubital tunnel release.
 

How long does cubital tunnel release take?

The procedure takes less than 20 minutes where the nerve is released, but if it is moved from behind the bony prominence on the inside of the elbow (epicondyle) to the front this adds an extra 15 minutes to the procedure.
 

What is the success rate?

When performed soon after the onset of symptoms, cubital tunnel release is generally very successful with over 90% of patients feeling immediate improvement in their symptoms, particularly pins and needles at night. Patients who have had a trapped nerve for many months or years may take longer to improve and there is the potential that the nerve may not recover fully.

People who have lost muscle mass due to severe and prolonged pressure on the nerve have the poorest prognosis, although surgery should always be considered to halt the progression of weakness in the hand.


Want Mr Wright’s expert medical opinion in your case? You can book an appointment with him now via his Top Doctor’s profile here.