Ulnar Nerve Decompression, or Cubital Tunnel Release, is a surgical procedure used to treat Ulnar Nerve Entrapment at the elbow. Also known as Cubital Tunnel Syndrome, Ulnar Nerve Entrapment is a pinched nerve at the elbow (ulnar nerve). Patients with this condition typically complain of numbness in the small finger and sometimes the ring finger. However, in more severe cases, patients may also experience weakness in the hand muscles, causing poor hand function.

Ulnar Nerve Decompression can improve and even reverse these symptoms in cases that have only affected the patient for a few months. In severe cases that have plagued the patient for many months or years, this procedure may prevent worsening symptoms but is less likely to reverse them.

This surgery takes around 20 to 40 minutes and is almost always done on an outpatient basis, which allows the patient to go home after surgery.

Who Needs It

Patients with confirmed presence of Ulnar Nerve Entrapment are typically diagnosed with various tests, including Nerve Conduction Studies/EMG, which are electrical tests that can help confirm the presence of the condition and define how severe it is. Ultrasound testing may also be performed as an alternative to nerve conduction studies that can also confirm the diagnosis.

A good candidate for Ulnar Nerve Decompression surgery has typically not responded well to conservative treatment options, including splinting the elbow straight at night and exercises that help get the nerve moving better behind the elbow.

How Does It Work

The patient is often given general anesthesia, which puts the patient to sleep to ensure they are comfortable and pain-free during the procedure. The surgical site is also numbed with a local anesthetic, or in some cases, the entire arm is numbed with medication (known as a "block") to control the pain during and after surgery. However, some patients are kept awake during the procedure and given various numbing and blood vessel constricting medications to provide pain control and prevent bleeding during the surgery.

In an open procedure, the most commonly performed Ulnar Nerve Decompression, the surgeon identifies the Osborne's ligament (also known as fascia) and carefully clears all of the tissue on top of this fascia. Scissors are then carefully used to open the fascia along the incision length. Once the nerve is completely released, the surgeon inspects it for damage. The surgeon then flexes and extends the elbow to ensure the nerve stays in the correct place.

If the nerve becomes unstable during the procedure and "jumps over" the elbow bone when the elbow moves, the surgeon may move the nerve in front of the bone to keep it in place when the patient moves their elbow. This procedure is referred to as an Ulnar Nerve Transposition and may also be done on patients with very severe compression of the nerve or in patients who previously had Cubital Tunnel Surgery and did not get better.

Recovery

After surgery, patients will feel groggy from the anesthesia if they were put to sleep and will need to rest until it wears off. Patients should be driven home by a family member or friend with either type of anesthesia used. The operative arm will be numb and weak if a block is used. Patients may be given a sling to use until strength returns, which can take a few hours. Pain will not likely be felt for a few hours due to the numbing medication/block given for the procedure.

Patients may be sent home with prescription pain medicine, which can be used for pain the first few days after surgery. However, many patients find that over-the-counter medications such as acetaminophen and ibuprofen are enough. Antibiotics are not commonly needed after surgery and will not be prescribed in most instances.

The dressing applied to the surgical site is typically removed after 5 to 7 days. After removing it, patients may shower with the site uncovered, but the wound should not be submerged in stagnant water, such as a river, pool or hot tub, for about 30 days. Patients with a splint applied after surgery should leave it on until otherwise instructed by the surgeon.

Patients with sedentary jobs, like those who work predominately at a computer, may feel up to returning to work a few days after the procedure. However, those with physically demanding jobs or participating in athletics will likely need to take two to four weeks off to heal properly.