Having a Cubital Tunnel Decompression

Is an operation always necessary?

The decision to operate in cubital tunnel syndrome is a shared one made by the patient with some guidance from the surgeon.

• There are some circumstances when a surgeon will strongly recommend surgery, particularly if there is loss of muscle function or severe changes on a nerve test.
• More commonly, there is no strong recommendation, and the operation is done to alleviate symptoms of tingling and numbness in the hand.

Alternatives to having an operation include:

Doing nothing - many people have intermittent or mild symptoms, and the symptoms tend to let you know if the nerve is under increasing pressure, so if you have not much in the way of symptoms, then doing nothing is a great option. You can always come back if things get worse. Avoiding the usual provoking factors is the usual advice given for early compression.
Wearing splints - night-time splints are said to help by keeping the arm out straight. It may be worth trying but very few people manage to keep a splint on all night comfortably!

What happens on the day of surgery?

On the day of the operation, you will be asked to report to XXXXXXXXXXXXXl. You can expect to be in hospital for anything between 2 and 6 hours, depending on the list order.

What should you do to prepare?

Read about Having an operation on your hand or arm. This runs through most of the risks involved with the surgery, and it is really important that you are aware of this risk before agreeing to the surgery.

Planning for when you get home is also important. Although there are no restrictions on how you use your hand after the surgery, your hand will not work the way you want it to in the first few weeks after the operation. You can help make things easier by:

• Making sure you have a good weeks supply of food and provisions in the house
• Having some ready meals or easy prep meals available
• Planning to wear loose fitting clothing such as joggers and t-shirts for the first few days

What type of anaesthetic is used?

Cubital tunnel decompression can be done under general or regional anaesthetic. The decision on which type of anaesthetic to use is one which should be discussed on the day of surgery with the anaesthetist.

What exactly does the surgeon do?

The surgeon makes a short incision over the ulnar nerve just beyond the elbow. The nerve is then released from the overlying tissues to relieve the pressure.

After the operation

The elbow will have a bulky bandage over the wound initially. This bandage can come off around 24 hours after the operation and there is a light dressing over the wound which stays in place until around 10 days after the operation. The wound needs to be kept clean and dry until it has fully healed (at around 2 weeks).

Is it safe to use the arm after the operation?

It is very safe to use the elbow, wrist and hand normally after the operation. You should We recommend that you keep the hand moving – touch your thumb to each fingertip in turn, fully straighten your fingers and then make a full fist around 10 times every half hour until your hand is working normally – this is for movement only, and you do not need to put any power into the fist!

What will the scar be like?

The scar is usually around 4cm long and quite tender to begin with. It generally settles quickly , but here is a rough guide:

• 2 weeks – Wound has healed. You should keep the wound clean and very dry until this point. It is usually safe to shower with the wound at 2 weeks, but wait until around 3 weeks before soaking it in a bath.
  
• 6 weeks – The scar is red and still tender. The area around the scar feels firm and tender. It is still uncomfortable to put pressure on the scar.
  
• 3 months – Usually by 3 months, the scar is no longer tender and you should have a full range of movement in the joints.
  
• 6-12 months – If there has been damage to the nerve from the compression, you should start to see recovery of nerve function between the 6 and 12 month mark.

What happens after the operation?

You will be discharged home within a couple of hours after the operation. The hospital rules state that you have to be accompanied home, so you will need to ask a friend or relative to come and pick you up.

The elbow will have a bulky bandage over the wound initially. This bandage can come off around 24 hours after the operation and there is a light dressing over the wound which stays in place until around 10 days after the operation. The wound needs to be kept clean and dry until it has fully healed (at around 2 weeks). The stitch used is usually buried under the skin so there is no need to have the sutures removed.

We usually put you in charge from here on in – if you need to see us, you can contact us as you feel necessary.

When is it safe to drive after the surgery?

Remember that it is your responsibility to ensure that you are safe to drive by law! Most people return to driving at around 2-3 weeks after their operation. There is further guidance on this on our Having an Operation page.

When is it safe to work after the surgery?

There are no restrictions on how you use your hand after the operation, so if you have a desk job you can potentially go back to work straight away. Most people with light manual jobs go back at around 2 weeks, but heavy manual workers might need longer than this.