Houston Methodist. Leading Medicine

Elbow FAQ

Question:

I wish I had never had surgery for my elbow problem. Why don't surgeons tell patients they can get worse instead of better? I have something called cubital tunnel syndrome. Nothing helped reduce the pain, numbness, or weakness so I opted for the surgery. Big mistake. Please tell your readers not to have surgery for this problem. It isn't worth it!

Answer:

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. Numbness on the inside of the hand and in the ring and little fingers is an early sign of cubital tunnel syndrome. The numbness may develop into pain. The numbness is often felt when the elbows are bent for long periods, such as when talking on the phone or while sleeping. The hand and thumb may also become clumsy as the muscles become affected. Tapping or bumping the nerve in the cubital tunnel will cause an electric shock sensation down to the little finger. This is called Tinel's sign. Grip strength may be affected to the point that the person can no longer lift objects or even hold a cup of coffee. This syndrome can be very disabling. Treatment usually begins with conservative (nonoperative) care. First, it is important to stop doing whatever is causing the pain in the first place. Taking frequent breaks during activities and even modifying job activities is important. Antiinflammatory medications, physical therapy, and splinting are helpful. The therapist will give you tips on how to rest your elbow and how to do your activities without putting extra strain on the elbow. It sounds like you may have gone through all the pre-operative kinds of treatment without help. For individuals like yourself, if the symptoms do not go away with changes in activity and nonsurgical treatments, then surgery to stop damage to the ulnar nerve may be recommended. The goal of surgery is to release the pressure on the ulnar nerve where it passes through the cubital tunnel. The hope is to reduce pain and other symptoms, possibly to even eliminate all symptoms. But a full recovery is rare. And even those patients who experience a good result at first often experience a return of their former symptoms. Patients like yourself express surprise and disappointment when they have a successful outcome and then the symptoms come back. The question arises: are these symptoms the same old (persistent) unchanged symptoms or are they a true recurrence of the previous problem? The answer to this question is really still unknown. Certainly it is possible that a patient can be so hopeful for improvement that they feet a change in their symptoms even when there was no change in the nerve physiology or function. And it is possible that another problem is present (e.g., painful neuroma over the nerve) that could be adding to the persistent symptoms. But studies show that removing the neuroma or performing a second surgery to take pressure off the nerve doesn't seem to help. If anything, patients report worse results after revision surgery. In fact, it is more often the case that the symptoms of pain or numbness, weakness, and muscle atrophy (wasting) are permanent. It's possible the first surgery was unlikely to change anything. It has been suggested by some hand surgeons that there could have been symptoms of nerve dysfunction for a long time before the patients ever noticed them. By the time the problem became obvious, damage to the nerve was permanent. There are some risk factors to suggest patients who might not be good candidates for surgery to treat cubital tunnel syndrome. These include depression or other mood disorders and/or problems with coping. Dissatisfaction with the results and disability are linked with these psychologic problems and may be the real key to poor outcomes. There is also the possibility that poor results occur because of the surgery itself. There are different ways to surgically treat cubital tunnel syndrome. Studies are needed to show which technique is the best with the fewest complications. Until the procedure is perfected, patients should be told what to expect realistically. Sometimes patients are advised carefully as to what to expect in terms of possible complications or problems but they don't remember this information later. We are sorry your situation has not improved. It may still be worth your time to see a hand therapist for some rehab. Special nerve gliding exercises may help keep the nerve moving freely and prevent scar tissue from forming around the nerve making your symptoms even worse. Amirhesam Ehsan, MD, and Douglas P. Hanel, MD. Recurrent or Persistent Cubital Tunnel Syndrome. In The Journal of Hand Surgery. September 2012. Vol. 37A. No. 9. Pp. 1910-1912.

*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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