Ulna Nerve Release
The ulnar nerve runs along the inside of your elbow and is the nerve that produces a shock down the arm when you bump your funny bone. When you hit your funny bone, you are actually hitting the ulnar nerve on the inside of the elbow. The ulnar nerve travels through the cubital tunnel at the elbow and then on to the hand. This tunnel is surrounded by soft tissue and bone which can narrow and squash the nerve. When this occurs, cubital tunnel syndrome may cause numbness, weakness or pain in the hand and pain on the inner side of the elbow. The hand may feel as if it is falling asleep, or pain can radiate from the elbow into the hand. This pain and numbness is restricted to the skin that is fed by the ulna nerve- the ring and little fingers of the hand.
Why have I got cubital tunnel syndrome?
Cubital tunnel syndrome occurs when the tunnel is compressed. Constant pressure on the nerve is the main cause, i.e. while you sit at a desk or from using the elbow rest during a long drive. When the ulnar nerve shifts out of its groove behind the elbow or stretches abnormally. It is often caused by flexing the elbow for long periods of time. The ulnar nerve can also be damaged from a blow to the cubital tunnel.
What is the non operatibe treatment?
Treatment options may include rest, immobilisation in a splint, cushioning of the nerve with an elbow pad and anti-inflammatory medications. The pain will settle if you just stop whatever is causing the symptoms. Reducing the amount of time you do activities that require a lot of bending in the elbow and take frequent breaks.
If your symptoms are mainly at night, a lightweight plastic extension splint may be worn to limit movement while you sleep and ease irritation. The nerve can be protected from external pressure with a soft cushioning pad worn around the elbow.
What is the operative treatment?
In severe cases of pain, numbness or weakness, surgery may be needed to relieve pressure on the nerve. Most patients who have painful cubital tunnel syndrome have surgery. The surgery is a 20 minute day case procedure under general anaesthetic but can be performed under local anaesthetic while you are awake if preferred. A tourniquet is used; which prevents blood from obscuring the surgeons view.
A 6 cm skin incision is made and then the soft tissues which are squashing the nerve are released. Having released these ligaments the elbow is bent and straightened to ensure that the nerve is stable and does not slip forward out of its groove behind the elbow. If it does the nerve needs to be permanently brought forward; an operation called a transposition. The skin is sutured and a bulky dressing is applied.
What to expect after surgery?
You can go home soon after the operation. The local anaesthetic will wear off after 4- 6 hours. Simple analgesia such as ibuprofen (unless contraindicated) will control the pain. Pain killers should be started before the anaesthetic has worn off and the hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. The bulky bandage should be removed by your GP practice nurse at 5 days, this will be arranged before you leave hospital. They will put a fresh sticky plaster over the wound if necessary. Gently bend and straighten the elbow straight away, this should be increased to full movement once the bulky dressings are removed. The sticky dressing can be removed at home, the sutures are usually absorbable and do not need to be removed. You will be seen back in clinic at 6 weeks. You should notice an improvement in symptoms within a week but the final result may be realised at about 3 months.
Return to work and driving
The wound should be kept dry for 2 weeks. Return to work and driving as soon as you feel able.
