Cubital Tunnel Release

Ulnar nerve release at the elbow
Summary

This operation is performed for a condition called cubital tunnel syndrome.  The aim of the operation is to release the ulnar nerve as it passes around the back of the elbow.  

Factors to Consider

Symptoms from cubital tunnel syndrome vary significantly between patients.  Some patients will suffer from mild pins and needles to the little and ring fingers whereas others will have numbness and weakness to the fingers.  The severity of your symptoms will dictate whether you should proceed to surgery.  However, if symptoms are very severe the nerve may not recover fully despite surgery.

A cubital tunnel release involves freeing the compressed ulnar nerve to allow the nerve to recover.  Recovery can take a long time as the nerve does not respond well to injury.  Therefore, some patients can take over a year to notice improvement.

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is performed through a 4cm incision on the inside of your elbow, over the nerve.  The surgeon will then identify the nerve and release the tight tissue that is compressing it.  Once the nerve is released the surgeon will make an assessment of how stable the nerve is during elbow movement.  Sometimes the nerve can flick over the bony prominence on the inside of the elbow.  Although rare, if this occurs, the surgeon will move the nerve to the front of this bony prominence.  This is called an ulnar nerve transposition.

The operation itself takes about 30 minutes.

Anaesthetic

The operation is usually performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The risk of infection is very small and is thought to be about 0.5%.  Most infections will settle simply with antibiotics.

Damage to nerves and blood vessels around the elbow can occur but this is rare.

The main risk is that your symptoms do not fully resolve.  The success of the surgery depends on how damaged the nerve is by the time of surgery.  It is good at preventing symptoms getting any worse and in most patients will give a significant improvement but this may take over a year to occur.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the elbow may be sore after it wears off.  You will be given a combination of pain killers to go home with.  It is important that you take regular pain relief so that you can start moving your arm early.  

Dressings

You will wake up with your arm in a bulky bandage.  This can be removed 2 days following the surgery and is used to help with swelling.    There will be dressings applied to the wound under these bandages.  These can occasionally come off and will need to be replaced during the first 2 weeks after surgery to protect the wound.  

The dressings are splash proof but not waterproof and so you should avoid getting them wet.

The wound is closed using dissolvable stitches.  The stitches do not need to be removed but there may be loops at each end of the wound that can be trimmed.  The nurses will arrange this to be done at your local GP practice before you are discharged.

You may be given a sling but this is only for comfort.  You can get rid of the sling as soon as you feel comfortable.

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you within 3 weeks of the operation.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road.  This will vary between patients but normally takes about a week.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable.  Your symptoms should be improved/improving by 3 months with the majority fully recovered by 6 months.  It can, however, take up to a year for some patients to fully improve.