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Cubital tunnel release

What is the cubital tunnel syndrome?

Cubital tunnel syndrome is a condition that indicates pressure or stretching of the ulnar nerve, causing numbness, tingling or weakness in the ring and small fingers.

The ulnar nerve is one of the three main nerves in the arm. It travels from the neck down to the hand and can be pinched in several places along its way. It goes through a tunnel of tissue (the cubital tunnel) that runs under a bump of bone inside the elbow. The nerve usually gets compressed here, which causes the typical neurological symptoms.

What are the causes of a cubital tunnel syndrome?

Tunnel syndrome can be associated with any condition that exerts pressure on the nerve. In case of a cubital tunnel syndrome, the ulnar nerve becomes compressed at the elbow by the surrounding tissues. The nerve is very vulnerable here, as it is running through a narrow space from the upper arm to the forearm and the permanent stretching and bending of the elbow could irritate the nerve.

The swell of the surrounding soft tissues could have several reasons. Mostly an elbow injury or a joint problem is responsible for the syndrome, but direct pressure (leaning the arm on the armrest for a long time), or permanent bending of the elbow (during sleep) could also contribute to its formation.

Systematic diseases, like thyroid dysfunction, rheumatoid arthritis, or diabetes could be accompanied by cubital tunnel syndrome.

Cubital tunnel syndrome is most common in young adults and middle-aged people, in both genders. The occurrence is more frequent in physical workers and athletes.

What are the symptoms of the cubital tunnel syndrome?

The symptoms of the cubital tunnel syndrome could be separated into two groups. As the ulnar nerve contains both sensory and motor nerves, the first group of symptoms is sensory symptoms, like numbness, loss of sensation, pain in the ring and small finger, or tingling. The other group of symptoms are motor deficits: the weakening of the grip and difficulty with finger coordination, in advanced stage muscle wasting in the hand could occur.

Cubital tunnel syndrome - symptoms and diagnosis

The elbow is usually swollen, pressure-sensitive, especially along the ulnar nerve, its range of motion is decreased.

At an early stage, symptoms are felt by night, but later also during the daily activities, when the elbow is bent for a long time, such as while holding a phone.

Electroneurogram - Medicover Hospital Hungary
Electroneurogram examination

How is cubital tunnel syndrome diagnosed?

The diagnosis of a cubital tunnel syndrome is usually set by an orthopedic specialist or a hand surgeon. The diagnosis has been set with the combination of a detailed history and physical examination in conjunction with the use of electrodiagnostic (EDX) testing for confirmation.

As cubital tunnel syndrome shows similar symptoms to disk herniation or circulatory system disorders, a special examination, electroneurogram (ENG) is recommended to confirm the diagnosis.

This examination helps to visualize directly recorded electrical activity of neurons in the central nervous system (brain, spinal cord) or the peripheral nervous system (nerves, ganglions). The nerve conduction velocity of a pressed nerve is very low, therefore ENG examination could verify the diagnosis.

X-ray is recommended to exclude possible bone fractures and injuries, and an articular ultrasound examination could help to ascertain the cause of the pressure.

What are the treatments for cubital tunnel syndrome?

Cubital tunnel syndrome is treated conservatively first, as it often relieves without surgery. A splint at night to keep the elbow from bending can help to reduce the swelling, making more space for the nerve in the tunnel. In severe cases, non-steroid anti-inflammatory medications and injections to the cubital tunnel could also contribute to the reduction of the swelling.

The surgical release of the cubital tunnel is the fastest and most effective treatment of the syndrome.

When is cubital tunnel release recommended?

If the conservative treatment didn’t take effect, or the decrease of the nerve conduction velocity is lower than the average, surgical intervention is recommended.

What happens during the surgery?

The surgery is always preceded by a personal consultation with the hand surgeon specialist. During the consultation, he provides detailed information about the necessary pre-operative tests, the process of the operation and its risks.

Cubital tunnel release is prepared as a one-day surgery.

The surgery is performed under general or regional anesthesia. During the cubital tunnel release surgery, the pressure on the ulnar nerve is decreased by cutting the scarred cubital tunnel ligament.

Cubital tunnel release - Medicover Hospital Hungary
Cubital tunnel release

The inflamed tissues around the tendons are removed at the same time, and at last, the surgeon closes the wound with a few stitches.

What are the risks of the surgery?

Like every surgical intervention, the cubital tunnel release may have risks and complications. Very rarely the operational area may become inflamed, infected, and the adjacent anatomical structures – tendons, muscles, blood vessels, nerves, neighboring bones – may get injured. In some cases, pharmaceutical treatment may be needed, while in more severe cases, the operation might have to be repeated.

What shall I do after the surgery?

After a few hours of medical monitoring, the patient can leave our hospital. The day after the surgery, the bandage should be changed, and the removal of the stitches is due 10 days after the intervention. During these days, keep the wound away from water.

Easy physical exercises of the arm, hand, and fingers are recommended 2 days after the surgery.

The wound may remain swollen, sensitive and painful for a few days after the surgery. Numbness and pain cease differently for every patient, usually a few days after the surgery. The full recovery, the regeneration of all functions of the hand, takes months, which can be facilitated with physiotherapy.

How much does a cubital tunnel release surgery cost?

The price of a cubital tunnel release is composed of several elements. At our hospital, the listed cubital tunnel surgery cost includes the surgery and the check-up one week after surgery.

We offer a separate consultation package for the first consultation, where the hand surgeon specialist decides if the surgery is recommended. The necessary pre-operative examinations can be taken at our hospital, which has an additional cost.

Our goal is to offer you the most reasonable cubital tunnel release price for the highest quality service and care.

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