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Ulnar Nerve Entrapment / Cubital Tunnel Syndrome

The ulnar nerve travels on the inside of the elbow and supplies muscles in the hand. When you hit the corner of your elbow on a hard surface – ‘the funny bone’ – you are actually hitting the ulnar nerve, which is why it is so painful.

The ulnar nerve supplies the small muscles in your hand which are responsible for gripping and pinching. It also gives the sensation to your little finger and the inside of the ring finger. When the ulna nerve becomes squeezed it is called ‘Cubital Tunnel Syndrome’.

There is no single cause for Cubital Tunnel Syndrome however any pathology that causes the tunnel to reduce in size may give rise to symptoms.

Patients usually report pain on the inside of the elbow which can be worse at night or after holding the elbow bent for a prolonged period of time. Pins and needles can travel down the inside of the elbow along the forearm into the little and ring fingers. These fingers can also be numb and can have a tingling feeling due to the dysfunction of the nerve.

A detailed history and careful examination will be required when you come to clinic. You will usually be sent for Nerve Conduction studies, which are a very specialised investigation involving several probes being placed on your arm. These are performed to confirm the diagnosis and the location of the site of nerve compression.

Non-operative measures include Extension Splints which are worn at night to stop the elbow from bending and stop the nerve from being stretched in the cubital tunnel. Most people however go on to require an operation.

The operation is a day case procedure meaning you will go home the same day as your surgery. The anaesthetist will see you before the operation and decide on which type of anaesthetic would be best. These will be either general anaesthetic where you will be asleep or regional anaesthetic which is an injection into the arm that make the entire arm go numb.

Surgery involves an incision over the nerve on the inside of the elbow approximately 2 inches in length. The nerve is released in the tunnel so that no compression occurs. On occasion the nerve can slip out of the groove that it normally sits in. If this occurs after release the nerve is moved forward to the front of the elbow (this is called a Transposition). Once stabilised it does not move around.

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Shoulder problems including pain, are one of the more common reasons for clinic visits for musculoskeletal symptoms. The shoulder is the most movable joint.

Aftercare

You will have a bulky compressive padded dressing applied at the time of surgery. This should be taken down 72 hours after surgery leaving the small local dressing over the wound. You will be discharged from hospital once you are comfortable and have had a drink. The wound is checked at 2 weeks and you will be seen in clinic at 6 weeks after the operation to check that your symptoms have improved. You will also see the physiotherapist after the operation to show you how to massage the scar.
This depends on the nature of your work. For a sedentary occupation the time off is normally 2 weeks. For a manual occupation this can be as long as 6 weeks.

It is normally safe to drive within 6-7 days of your operation but can take up to 2 weeks before you are completely comfortable to start driving.

It is normally safe to drive within 6-7 days of your operation but can take up to 2 weeks before you are completely comfortable to start driving.

Like with any surgery there are a number of small risks associated with this operation.

Infection

(1%) is a risk with all surgery.  In the majority of cases these are infections around the wound and can be treated with a course of antibiotics.  The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.

Swelling and Stiffness

Can remain for many months following surgery.  It is important to elevate the limb and keep all joints that are not immobilised, active.

Nerve Injury 

Is a potential but very rare risk with this surgery.  Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome.  Injury to the Ulnar nerve itself is extremely rare and can in the worst case, result in permanent weakness or numbness in the hand.

Recurrence 

Is an unusual complication.  You may however find that the symptoms recur some time after the original operation having completely settled initially.  In this rare event a second operation may be necessary.

Residual Numbness and Weakness 

Is a problem when the symptoms have been present for a long time prior to the operation.  If you have complete numbness in your fingers prior to surgery there is a risk that the feeling may not completely return.  This is due to scarring in the nerve from the prolonged pressure.  It is important to note however that it can take up to 18 months for the feeling to completely return. However if your hand has become so weak that the muscles have disappeared then it is highly unlikely they will recover.

Complex Regional Pain Syndrome 

Is an extremely rare (1%) complication that can follow any injury or surgery to a limb.  In this situation the nerves in the arm over-react to the point where the hand becomes very painful, swollen and sensitive.  This condition does improve with time but can be problematic for many months.

What our patients who have treated in our Clinic did say?

Patient
Patient
BMI The Beardwood Hospital
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From start to finish I received the utmost care and consideration from Mr Hadi. He took time to listen to my history and then go through the procedure with myself . The course of treatment provided was very effective as was the aftercare. I do not feel he could have done anymore.
Patient
Patient
BMI The Beardwood Hospital
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What a lovely man. Explained everything fully and gave me options regarding treatment including surgical repair which I opted for. I was treated with kindness and respect. The surgery was carried out efficiently and after care was superb. Would definitely recommend Mr Hadi.
Patient
Patient
Royal Blackburn Teaching Hospital
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Recently needed an operation on my shoulder. The treatment I received was second to none. Mr Hadi explained everything fully beforehand, making sure I was fully informed and again was exceptional in my aftercare and recovery. I felt supported and valued as a patient. Professional and approachable throughout. Highly recommend! Thank you.
Patient
Patient
BMI The Beardwood Hospital
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I could not have asked for better care. Excellent bedside manner, totally professional, would highly recommend.
Patient
Patient
BMI The Beardwood Hospital
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The information i was given during treatment was great, al my questions were answered in a way I understood. I was never made to feel my questions were stupid. Really great experience
Patient
Patient
BMI The Beardwood Hospital
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Mr Hadi has a real understanding of making patients feel assured and at ease at all stages of treatment. He explains the pros and cons of the procedure and gives you time to decide if you want to go ahead
Patient
Patient
BMI The Beardwood Hospital
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I have had a few operations over the years on my shoulder, and I didn't see results straightaway, I was told it may not improve at all, however last year I underwent another operation on my shoulder. 12 months later I am less pain now than I was from my original operation in 2008.
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