Cubital tunnel release

Overview

The ulnar nerve passes through a narrow tunnel behind the medial epicondyle of the elbow — the 'funny bone' region. When the nerve is compressed in that tunnel, patients develop numbness in the ring and small fingers, weakness of grip and pinch, and eventually muscle wasting in the hand. Surgical release decompresses the nerve when conservative care is not enough.

How the Procedure Works

We open the fascial roof of the cubital tunnel and trace the ulnar nerve proximally and distally, releasing every compressive band along its course — the arcade of Struthers proximally, the cubital tunnel retinaculum at the epicondyle, and the fascia between the two heads of the flexor carpi ulnaris distally. Simple in-situ decompression works well when the nerve lies stable in its groove. If the nerve subluxates anteriorly over the medial epicondyle when the elbow bends — which creates a repetitive traction injury — or if the tunnel itself is too narrow to decompress adequately, we transpose the nerve to the front of the elbow, placing it in a submuscular or subcutaneous position where it travels a straighter path without snapping. The medial antebrachial cutaneous nerve branches cross the field and must be identified to avoid a painful postoperative neuroma.

When to Consider Cubital Tunnel Release

Cubital tunnel release is generally offered when symptoms, imaging, and a trial of non-operative care together point to surgery as the next step. The typical picture includes:

Ulnar neuropathy symptoms
Numbness and tingling in the ring and small fingers, weakness of grip or pinch, or intrinsic muscle wasting.
Failure of conservative care
Activity modification, night splinting to keep the elbow straight, and a course of therapy that have not resolved symptoms.
Confirmed compression
Electrodiagnostic studies confirming ulnar nerve compression at the elbow.