DAVE WATTS, MD
Cubital Tunnel Syndrome
It is a surgical procedure performed to correct cubital tunnel syndrome.
What is Cubital Tunnel Syndrome?
An area of the elbow known as the cubital tunnel, when compressed is called cubital tunnel syndrome.
The ulnar nerve passes through the back of the elbow behind bony bump, also known as medial epicondyle. The passageway is called cubital tunnel. The bone, muscle and ligaments form a narrow passage with the ulnar never at its center. There is a layered roof of soft tissues on top called fascia. Upon stretching of the elbow, the ulnar nerve stretches and catches the bony bump. The compression of the ulnar nerve or its entrapment can cause tear and make it become inflamed, causing different types of problems.
Symptoms of Cubital Tunnel Syndrome
The issue of cubital tunnel syndrome developed over time. If left untreated, cubital tunnel syndrome can lead to permanent nerve damage in the hand. Most commonly found causes leading to cubital tunnel syndrome include tingling, pain, and intermittent numbness in ring finger or little finger inside the hand. Most of these symptoms are more evident at night.
Sometimes, an injury to the elbow like dislocations, fractures, or direct blow can cause tissue swelling, compressing the ulnar nerve in the cubital tunnel. Sports or work related activities involving flexion movements increase the risk of developing cubital tunnel syndrome. The repetitive bending and straightening of elbow can also inflame or irritate the ulnar nerve. Sometimes, leaning on the elbow for longer periods of time can also lead to ulnar nerve irritation. Cubital tunnel syndrome can also be caused by bone spurs, ganglion cysts, and tumors.
The conservative treatment options are recommended for treating cubital tunnel syndrome at first. The options for conservative treatment of cubital tunnel syndrome include wearing a brace or splint at night, or sleeping at an angle which keeps the elbow straight. One conservative of treating cubital tunnel syndrome is to wrap the arm loosely in a towel and apply tape to it to hold it in place.
Sometimes, conservative treatment options do not treat the cubital tunnel syndrome. Surgery is recommended when there is presence of muscle wasting or severe nerve compression. In these cases the orthopedic surgeon may recommend a surgical procedure for treating cubital tunnel syndrome.
Surgeries for Treating Cubital Tunnel Syndrome
Ulnar Nerve Transposition
In Ulnar Nerve Transposition, the surgeon creates a new tunnel in front of the medical epicondyle to transpose the ulnar nerve to the new tunnel.
In this surgical procedure, the surgeon removes the medial epicondyle (bony bump inside the elbow) to help the ulnar nerve smoothly glide upon flexing and straightening of the elbow.
The choice of surgery depends on the type of cubital tunnel syndrome faced by the patient.
The medial epicondylectomy procedure involves the surgeon cutting open the soft tissue roof to expose the ulnar nerve. The surgeon will cut the forearm or flexor muscles, detaching them from the epicondyle. The use of special instruments let the surgeon shave away the bump, freeing the ulnar nerve to smoothly glide within the cubital tunnel. The surgeon will reattach the flexor muscles to the area of shaved bone in the special sutures, closes the sutures, and covers the dressing.
In nerve transposition, the surgeon will make an incision over the medial epicondyle to cut open the cubital tunnel through the soft tissue roof for exposing the ulnar nerve. The surgeon cuts the forearm muscles and detaches them from the epicondyle. The surgeon moves or transposes the ulnar nerve behind the elbow to a new location in front of the elbow. The ulnar nerve may be placed by the surgeon above, within or under the flexor muscle. It depends on the type of cubital tunnel syndrome. Once the surgery is completed, the surgeon will suture back the flexor muscles and reattached using special sutures. The incision is closed and covered with a dressing.
In most of the surgical procedures performed for treating cubital tunnel syndrome, there involve no complications. However, some of the complications may include.
The symptoms may not improve with the surgery and remain the same as they were before.
Instability of the elbow.
Elbow flexion contracture.
Pain at the site of the scar.
The damage to the nerve which causes permeant areas of numbness around elbow or forearm.