What is Endoscopic Cubital Tunnel Release?
Endoscopic cubital tunnel release is a minimally invasive surgical procedure to decompress the ulnar nerve for the treatment of cubital tunnel syndrome. Endoscopic refers to the surgery being performed utilising an endoscope - a thin, flexible fibre-optic tube with a camera, light, magnifying lens, and a port to pass tiny surgical instruments.
The ulnar nerve provides sensation to the pinky and ring fingers and the inner side of the hand and forearm. It also innervates numerous small muscles of the hand which are crucial for fine motor skills and a strong grip. Compression of the ulnar nerve can lead to a tingling sensation, numbness, pain, and weakness in the arm.
Cubital tunnel syndrome is a condition characterised 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 centre. 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 endoscopic 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, thereby resolving symptoms.
Indications for Endoscopic Cubital Tunnel Release
Endoscopic cubital tunnel release is recommended when symptoms restrict your normal daily activities and fail to respond to conservative treatment such as medications, physical therapy, and steroid injections. These symptoms 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 Endoscopic Cubital Tunnel Release
Preoperative preparation for endoscopic cubital tunnel release will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a week 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 after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Endoscopic Cubital Tunnel Release
Endoscopic cubital tunnel release is usually performed in an outpatient setting and takes less than an hour. The surgery involves the following steps:
- General or local anaesthesia is administered to the patient.
- Your surgeon first locates the bony bump on the inside of the elbow and cleans the surgical area with an antibacterial solution.
- A small 2 cm incision is made behind the bony bump to access the ulnar nerve passing via the bony pathway called the cubital tunnel.
- Surgical tools called retractors are used to separate the edges of the incision and draw back superficial nerves from the ulnar nerve.
- Your surgeon then inserts an endoscope to examine the condition of the ulnar nerve and its surrounding structures.
- The camera attached to the endoscope is connected to an external video monitor in the operating room and the scope displays the internal structures of the elbow on the video monitor for your surgeon to view.
- Your surgeon passes miniature surgical instruments through the endoscope while looking at the monitor and divides the roof of the cubital tunnel to relieve pressure on the ulnar nerve.
- After decompression, your surgeon manipulates the elbow in different directions to evaluate the stability of the ulnar nerve.
- 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 instructions and recovery after endoscopic cubital tunnel release will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover.
- Most patients will be discharged the same day of the surgery, however, some may require an overnight hospital stay.
- You may notice some pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- 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 on the operated area is also advised to prevent stiffness and swelling.
- Physical therapy and range of motion exercises are recommended to restore mobility and strengthen the elbow 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.
- Majority of the patients are able to resume most of their normal activities within a week.
- Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
- Do not drive until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Benefits of Endoscopic Cubital Tunnel Release
Endoscopic cubital tunnel release surgery has the following advantages when compared to traditional open cubital tunnel surgery:
- Smaller incision
- Minimal muscle trauma
- Faster recovery
- Reduced postoperative pain
- Minimal scar tissue formation
- Lower risk of damage to adjacent nerves and blood vessels
Risks and Complications
Endoscopic cubital tunnel release is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Bleeding
- Anaesthetic reactions
- Infection
- Nerve, vessel, or tendon damage
- Elbow instability
- Persistence or recurrence of ulnar nerve-related symptoms such as pain, stiffness, numbness, or weakness
- Need for additional surgery
