How is the procedure performed?
The procedure is performed under a combination of general and regional anaesthesia. Three different procedures may be performed, depending on the individual circumstances:
Cubital tunnel decompression: An incision is made just behind the bony prominence on the inner aspect of the elbow. The ulnar nerve is identified above the point where it enters the cubital tunnel. The band forming the roof of the tunnel is divided and the nerve is freed from any pressure.
Anterior transposition: In this procedure the nerve is decompressed and moved into a location in front of the elbow (a procedure known as “ulnar nerve transposition”). This may be necessary if the bed of the nerve is scarred or damaged as a result of a fracture or if the elbow is deformed.
Medial epicondylectomy: If the bone in the region of the medial epicondyle is sharp or prominent, the bone may occasionally be removed (a “medial epicondylectomy”).
Benefits
The main benefit of the procedure is to relieve symptoms and prevent worsening of the condition. More than 80% of patients achieve benefit from surgery. Tingling and pain will often improve within weeks. Recovery of feeling may take many months. Shrinkage of muscles may not recover fully.
Risks
The overall risk of complications is less than 10%.
Nerve injury – Injury to the ulnar nerve is possible but rare.
Infection – Infection after this type of surgery is rare.
Neuroma – Occasionally damage may occur to one of the nerves to the skin which runs across the region of the scar. This may result in a sensitive or tender scar. This may rarely require further surgery.
Stiffness – Stiffness may occur after anterior transposition particularly if the elbow has been splinted for any length of time.
Instability – instability may occur after medial epicondylectomy if excessive bone has been removed as this may damage the attachment of the collateral ligament.
Aftercare
Following the procedure, the skin incision will be closed with sutures and tape and then covered with a shower-proof dressing, which should be left undisturbed until the sutures are removed at 12-14 days. A padded bandage will be applied to protect the elbow. Prior to discharge from hospital a physiotherapist will provide instructions about looking after the elbow. You should keep the arm elevated as much as possible to limit swelling and keep the hand, wrist and shoulder moving. The padded bandage is removed after 2 days and you may be allowed to start moving the elbow. Early movement is important to allow the nerve to glide and prevent scarring around it. Occasionally the elbow may be splinted for upto 2 weeks after surgery. Sutures are removed at 2 weeks after surgery.
Resuming activities
You may resume driving at approximately 2 weeks after surgery. Return to work will depend on your occupation. Manual activities should be avoided for at least 4 weeks. Non-contact sports may be resumed at 3-4 months.
Follow-up
An appointment will be arranged for you to be seen 2 weeks after the procedure. Follow-up is required for at least 3-6 months after surgery or until a satisfactory recovery is achieved.