Compression Neuropathy

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a common, painful, progressive condition that is caused by the compression of the median nerve at the wrist area.

The common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except the little finger, pain and burning sensation in your hand and wrist that may radiate up the arm and elbow, and weakness in hand with diminished grip strength.

Carpal Tunnel Release Surgery

If conservative treatment options fail to resolve the condition your surgeon may recommend a surgical procedure.

Carpal tunnel syndrome can be treated with carpal tunnel release surgery. Traditional surgery involves an incision of up to 2 inches in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.

Postoperative Care for Carpal Tunnel Release Surgery

Your surgeon may suggest you practice certain postoperative procedures for better recovery and to avoid further complications.

• Elevate your hand above heart level to reduce swelling.
• Wear a splint.
• Apply ice packs to the surgical area to reduce swelling.
• Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
• Physical therapy may be ordered to restore wrist strength.
• Eating a healthy diet and not smoking will promote healing.

Risks and Complications of Carpal Tunnel Release Surgery

Most often, you will not suffer any complications following carpal tunnel release surgery. However, sometimes you may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.

What is Cubital Tunnel Release?

Cubital tunnel release is a surgical procedure to correct cubital tunnel syndrome.

Cubital tunnel syndrome is a condition characterized by compression of the ulnar nerve in an area of the elbow called the cubital tunnel. The ulnar nerve travels down the back of the elbow behind the bony bump called the medial epicondyle, and through a passageway called the cubital tunnel. The cubital tunnel is a narrow passageway on the inside of the elbow formed by bone, muscle, and ligaments with the ulnar nerve passing through its center. The roof of the cubital tunnel is covered with a soft tissue called fascia. When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump. When the ulnar nerve is compressed or entrapped, the nerve can tear and become inflamed leading to various symptoms, and is called cubital tunnel syndrome.

The goal of cubital tunnel release surgery is to reduce the pressure on the ulnar nerve by providing more space for the nerve to move freely and to increase blood flow to promote healing of the ulnar nerve.

Anatomy of the Ulnar Nerve

The ulnar nerve is one of the three major nerves in the arm. It begins in the neck region and passes via the shoulder down the arm into the wrist and fingers. It provides sensation to the forearm and 4th and 5th fingers of the hands. It also regulates most of the little muscles in the hand that assist with fine movements plus some of the bigger muscles in the forearm that assist in accomplishing a strong grip.

Indications for Cubital Tunnel Release

Some of the indications for cubital tunnel release include:

• Persistent and intermittent tingling and numbness in the 4th and 5th fingers
• A feeble grip in the affected hand
• A sense of “falling asleep” of the 4th and 5th fingers
• Muscle weakness and impaired muscle function in the fingers
• Difficulty controlling fingers for specific tasks
• Tenderness and pain in the elbow joint
• Sensitivity to cold temperatures

Preparation for Cubital Tunnel Release

Preoperative preparation for cubital tunnel release will involve the following steps:

• A thorough examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Routine blood work may be ordered to look for any abnormalities that might complicate surgery.
• X-ray, CT scan, or MRI scan are ordered to assess the surrounding structures and condition of the ulnar nerve.
• You will be asked if you have any allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you may be taking.
• You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for a week or two prior to surgery.
• You should refrain from alcohol or tobacco at least 24 hours prior to surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home as you will not be able to drive yourself post surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Cubital Tunnel Release

If nonsurgical treatment measures such as anti-inflammatory medications, braces or splints, exercises, and physical therapy fail to provide satisfactory relief to cubital tunnel syndrome, cubital tunnel release surgery is employed as a final measure.

The procedure is mostly performed in an outpatient setting and usually takes less than an hour. The procedure involves the following steps:

• General or local anesthesia is administered to the patient.
• A 3- to 4-inch incision is made on the inner aspect of the elbow to access and visualize the ulnar nerve.
• Your surgeon then cuts and separates the overlying ligament or removes the bony bump compressing the ulnar nerve thus creating more space in the cubital tunnel for the ulnar nerve to move smoothly.
• After confirming adequate decompression of the ulnar nerve in the cubital tunnel, the overlying soft tissue and skin are closed with sutures and sterile bandages are applied.

Postoperative Care and Recovery

In general, postoperative care and recovery after cubital tunnel release involve the following:

• You will be transferred to the recovery area to be monitored until you are awake from the anesthesia.
• Your nurse will monitor your blood oxygen level and other vital signs as you recover.
• You will be placed in a sling for the first few days with instructions on restricted activities.
• You are advised to keep your arm elevated above your chest for a day or two while resting to prevent swelling and pain.
• You may be advised to wear a splint on your elbow for a couple of weeks to help the area heal.
• You are encouraged to gently exercise your fingers, elbow, and shoulder to prevent stiffness.
• Application of ice packs is advised to prevent stiffness and swelling.
• You may notice some pain and discomfort in the elbow and hand area. Medications will be provided for your comfort.
• Anti-nausea medications will be prescribed as needed for discomfort associated with anesthesia.
• Physical therapy and range of motion exercises are recommended to restore mobility and strengthen the joints and muscles.
• You should keep your surgical site clean and dry for at least 48 hours. Instructions on surgical site care and bathing will be provided.
• Refrain from strenuous activities or lifting heavy objects for at least a month. Gradual increase in activities over a period of time is recommended.
• You will be able to resume most of your normal activities within a week.
• A follow-up appointment will be scheduled to monitor your progress.

Benefits of Cubital Tunnel Release

Some of the benefits of the cubital tunnel release procedure include:

• Improves arm function
• Alleviates numbness and pain
• Prevents permanent damage to the ulnar nerve

Risks and Complications of Cubital Tunnel Release

Cubital tunnel release surgery is a relatively safe procedure; however, as with any surgery, there are risks and complications that could occur, such as:

• Persistent pain, stiffness, numbness, or weakness
• Bleeding
• Anesthetic reactions
• Infection
• Nerve, vessel, or tendon damage
• Need for additional surgery
• Continued or recurrence of ulnar nerve-related symptoms