Cubital Tunnel Syndrome
What is it?
The ulnar nerve is one of the nerves in the wrist that supplies the sensation to the ring and little fingers. It also supplies some of the muscles that move the thumb. The nerve travels from the neck, around the elbow in via a tight space called the cubital tunnel, into the hand. Compression of this nerve at the elbow causes symptoms of pins and needles, numbness, pain and weakness in the fingers and hand.
What causes it?
In the vast majority of people there is no obvious cause, however it is more common in middle age. People with arthritis, diabetes or a previous history of elbow trauma are more prone to cubital tunnel syndrome.
What are the symptoms?
The vast majority of people present with symptoms of pins and needles in the ring and little finger. This may occur during use of the hand and is often worse at night, disturbing sleep. Many people complain of wrist and hand pain that radiates into the arm.
More serious or longstanding cases may present with permanent numbness in the fingers, weakness of grip strength and inability to perform fiddly tasks such as doing up buttons.
Do I need any further investigations?
Cubital tunnel syndrome is a clinical diagnosis, however nerve tests, called EMGs, to assess how severely the nerve is compressed and damaged are carried out as it allows Andy to confirm the diagnosis and attempt to predict the likely outcome of surgery. The test also helps to rule out other causes of the symptoms such as problems in the neck. Often the tests come back showing "normal" or only slightly abnormal results despite serve symptoms. In these cases Andy will generally recommend an operation but this may only halt the progression of symptoms and not cure then completely.
What is the treatment?
Initial treatment of the symptoms may take the form of splinting to help ease the numbness. This is designed to keep the elbow straight at night and prevent stretching of the nerve. This may help in mild cases but generally are of little benefit in longstanding or severe disease. If you have a medical condition or injury which can cause the symptoms this will be investigated.
Surgery to release the nerve from the tight tunnel is a very common, quick and simple operation. It involves making a small 5-7 cm incision on the inside of the elbow and dividing the tight tissue that surrounds the ulnar nerve. This procedure is carried out under general anaesthetic as a day case procedure and takes around 15 minutes. In general the operation is relatively successful in halting the progression of symptoms, and many people find that their symptoms improve or resolve with time. It may take up to 12 months for the nerve to recover. If the nerve is badly compressed or you have had symptoms for a long time, you may not have full resolution of symptoms. Andy will explain this to you at the time of consultation.
How long will it take to recover?
Recovery from this operation takes about 2 weeks. A bulky bandage will be applied to the elbow after the operation to limit your movement and allow your wound to heal. You will be seen by a physiotherapist at 2 days who will give you exercises to get the elbow moving gently. The bandage will be removed at 1 week.
The stiches are under the skin but will need to be trimmed at 2 weeks, at which point Andy will review you in clinic.
Following your 2 week appointment your physiotherapist will get you moving your hand more and more and will also advise how to help soften and desensitize the scars.
What are the potential complications?
Any surgical procedure carries risks, however every effort is made to minimize these to ensure the best possible outcome from your surgery.
- Infection - Uncommon and usually treated very successfully with antibiotics
- Delayed healing - Smokers and those with diabetes are more prone to this
- Painful/Tender Scars - the vast majority of patients complain of some discomfort around the scar but it generally resolves with time. Rigorous wound care and desensitization as directed by your physiotherapist will help prevent this.
- Stiffness - Operations to the elbow may cause stiffness, this can be minimized by working closely with your hand therapist and getting your hand moving as early as possible.
- Incomplete resolution of your symptoms - this may occur if you have had severe compression of the nerve, or have had the symptoms for a long time. Mr. Hacker will advise you if he feels you might be at risk of this.
When can I get back to normal activities?
The wound MUST be kept clean and dry for 10 days until the sutures are trimmed. You should be able to return to "desk job" type activities within a few days of the operation. Any manual work, heavy lifting or sporting activities should be avoided for at least 4-6 weeks.
You may return to driving in about a week. Please inform your insurance company that you have recent hand surgery to ensure that are happy for you to do so.