Houston Methodist. Leading Medicine

Elbow FAQ

Question:

I have suffered with chronic cubital tunnel syndrome. I feel like an expert on the subject. But what I can't decide is whether or not to have the nerve transposition surgery. Two surgeons have recommended this to me now. I just don't know. What do you advise?

Answer:

With your self-study you now know that cubital tunnel syndrome is a condition that affects the ulnar nerve where it crosses the inside edge of the elbow. The symptoms are very similar to the pain that comes from hitting your funny bone. When you hit your funny bone, you are actually hitting the ulnar nerve on the inside of the elbow. There, the nerve runs through a passage called the cubital tunnel. When this area becomes irritated from injury or pressure, it can lead to cubital tunnel syndrome. When pressure on the nerve is severe enough, constant pain, numbness, and electric shock sensations make it difficult to perform daily tasks at home and at work. The problem is usually treated conservatively with nonoperative care. Anti-inflammatory medications may help control the symptoms. The early symptoms of cubital tunnel syndrome usually lessen if you just stop whatever is causing the symptoms. This is called activity modification. Since surgery has been recommended, we are assuming you have explored all nonsurgical options. The goal of surgery is to release the pressure on the ulnar nerve where it passes through the cubital tunnel. There are two different kinds of surgery for cubital tunnel syndrome. It is not clear whether one operation is better than the other. Ulnar nerve transposition (the one you are considering) involves the formation of a completely new tunnel from the flexor muscles of the forearm. The ulnar nerve is then moved (transposed) out of the cubital tunnel and placed in the new tunnel. The other method simply removes the medial epicondyle on the inside edge of the elbow, a procedure called medial epicondylectomy. By getting the medial epicondyle out of the way, the ulnar nerve can then slide through the cubital tunnel without pressure from the bony bump. You can see images to illustrate both of these operations here: A Patient's Guide to Cubital Tunnel Syndrome Recovery after elbow surgery depends on the procedure used by your surgeon. If you only had the medial epicondyle removed, you'll have a soft bandage wrapped over your elbow after surgery. Therapy can progress quickly after this type of surgery. Treatments start out with range-of-motion exercises and gradually work into active stretching and strengthening. You just need to be careful to avoid doing too much, too quickly. Ulnar nerve transposition can be a delicate operation. Studies report variable results. Therapy goes slower after ulnar nerve transposition surgery. You could require therapy for three months. This is because the flexor muscles had to be sewn together to form the new tunnel. Your elbow will be placed in a splint and wrapped in bulky dressing, and your elbow will be immobilized for three weeks. When the splint is removed, therapy will begin with passive movements. In passive exercises, your elbow is moved, but your muscles stay relaxed. Your therapist gently moves your arm and gradually stretches your wrist and elbow. You may be taught how to do passive exercises at home. Active therapy starts six weeks after surgery. You begin to use your own muscle power in active range-of-motion exercises. Light isometric strengthening exercises are started. You may begin careful strengthening of your hand and forearm by squeezing and stretching special putty. These exercises work the muscles without straining the healing tissues. At about eight weeks, you'll start doing more active strengthening. Your therapist will give you exercises to help strengthen and stabilize the muscles and joints in the wrist, elbow, and shoulder. Other exercises are used to improve fine motor control and dexterity of the hand. Some of the exercises you'll do are designed get your elbow working in ways that are similar to your work tasks and sport activities. Your therapist will help you find ways to do your tasks that don't put too much stress on your elbow. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems. Your hesitation suggests the need for more time and perhaps more discussion with your surgeon. With this new information, you may have some additional thoughts and questions for your surgeon that will help you make the final decision. Move at the pace of guidance and listen to your own internal sense of direction and purpose. Qiyan Shi, MD, MSc, et al. Predictors of Surgical Outcomes Following Anterior Transposition of Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review. In The Journal of Hand Surgery. December 2011. Vol. 36A. No. 12. Pp. 1996-2001.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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