Cubital tunnel syndrome

What is ulnar nerve entrapment?

Ulnar nerve entrapment at the elbow, also known as cubital tunnel syndrome, is a condition resulting from compression of the nerve at the elbow level. The ulnar nerve passes through a specific groove in this area, where it can be prone to compression and irritation.

The causes of the condition can vary. Compression may be related to anatomical factors, repetitive strain, or inflammation. These changes disrupt the proper functioning of the nerve, leading to sensory issues and, in more advanced cases, weakness of the hand muscles.

What are the symptoms of ulnar nerve compression?

Characteristic symptoms include pain and numbness in the little and ring fingers (the fifth and fourth digits). Sensory disturbances in these fingers may also occur.

As the condition progresses, grip strength may weaken. In more advanced stages, atrophy of the intrinsic hand muscles, which are responsible for some precise finger movements, may also occur.

The extent of the symptoms and the degree of nerve damage are assessed by the surgeon during a consultation and based on the results of diagnostic tests.

When is surgery considered?

The decision to proceed with surgery is made by a surgeon after examining the hand, taking a detailed medical history, and analyzing test results. The degree of nerve damage and the extent of sensory impairment and hand weakness are key factors.

The goal of the surgery is to relieve pressure on the ulnar nerve. Releasing the nerve can reduce pain and numbness, and create the conditions for gradual sensory regeneration and improved hand function.

What does surgery for ulnar nerve compression syndrome involve?

The surgery involves cutting the structures that are compressing the ulnar nerve within the groove at the elbow. The scope of the procedure is tailored to the anatomical conditions and the type of changes identified during the qualification process.

In some cases, simply releasing the nerve may not be enough. It may be necessary to move it out of its current groove and place it in a new position. This procedure is known as anterior subcutaneous transposition of the ulnar nerve.

The procedure is usually performed under regional anesthesia, specifically a brachial plexus block. This numbs the limb being operated on.

A pressure cuff is placed on the arm so that the procedure can be performed in a bloodless field. After the surgery, a thin drain is left in the wound. It is removed the following day during the dressing change. The surgical site is secured with a cocoon dressing that keeps the elbow flexed.

How to prepare for the surgery?

Full diagnostics are necessary before the procedure. An EMG test allows for the assessment of the degree of nerve damage and functional impairment. An ultrasound provides an image of the nerve structure at the site of compression, which helps in planning the scope of the surgery.

During the consultation, the surgeon takes a detailed medical history, examines the hand, and analyzes diagnostic results. They also order the basic laboratory tests required for the procedure.

Before surgery, medications that affect blood clotting may need to be temporarily discontinued or adjusted. The decision is always made by a doctor. Do not stop prescribed treatment on your own. During the consultation, you must inform the doctor about all medications you are taking.

Preparation also includes:

• discontinuation of nicotine products,
• removal of jewelry from the hand being operated on,
• removal of artificial nails is recommended.

Recovery after ulnar nerve surgery

Immediately after the procedure, the surgical site is secured with a cocoon dressing that keeps the elbow flexed. The arm should be kept in a sling with the elbow bent for about 2.5 weeks. This ensures optimal conditions for the healing of structures cut during the surgery.

A drain left in the wound is removed the following day during the dressing change. Stitches are removed after approximately 14 days.

Pain associated with nerve compression often subsides very quickly. However, the return of normal sensation requires nerve regeneration, which can take anywhere from a few weeks to several months. The recovery time depends on factors such as the severity of the condition, the patient's age, and any coexisting illnesses.

Exercises and hand rehabilitation

Appropriate physical exercises are important in the recovery process. Their scope should be tailored to the healing stage and performed according to the instructions provided.

Gradually working on grip strength is also an essential part of the recovery process. Exercises support the restoration of limb mobility and hand function, but you should not increase their intensity on your own.

The pace of recovery is individual. It depends primarily on the extent of nerve damage prior to surgery, the rate of regeneration, the patient's age, underlying health conditions, and consistent adherence to prescribed exercises.

What results can be expected after the surgery?

The goal of the surgery is to decompress the ulnar nerve. This can reduce pain and numbness in the little and ring fingers, and create the conditions for a gradual improvement in sensation and hand strength.

Pain may subside quickly, but nerve regeneration takes longer. Full recovery of sensation can take several weeks or months.

The extent of the final result depends on the stage of the disease prior to surgery. For this reason, the timeline and recovery process may vary from patient to patient.

Contraindications to surgery

The procedure is contraindicated in the case of:

• active skin infection in the surgical area,
• uncontrolled chronic diseases, such as diabetes or hypertension,
• blood clotting disorders.

The final decision regarding surgical qualification is made by the surgeon. This takes into account the condition of the nerve and the operated limb, diagnostic results, comorbidities, and the patient's general health.

‍