What is Endoscopic Cubital Tunnel Release?

Cubital tunnel syndrome is a condition that occurs when the ulnar nerve in the elbow is compressed, leading to symptoms like numbness, pain, and weakness. The ulnar nerve provides sensation to the pinky and ring fingers, as well as numerous small muscles in the hand that are essential for fine motor skills. The cubital tunnel, a narrow passageway on the inside of the elbow, is where the ulnar nerve passes through. The tunnel is formed by bone, muscle, and ligaments, with the roof being covered with fascia. When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump called the medial epicondyle, causing it to become inflamed and leading to various symptoms.

Endoscopic cubital tunnel release is a minimally invasive surgical procedure that aims to decompress the ulnar nerve and treat cubital tunnel syndrome. The surgery is performed utilizing an endoscope, a thin, flexible fiber-optic tube with a camera, light, magnifying lens, and a port to pass tiny surgical instruments. By providing more space for the nerve to move freely and increasing blood flow to promote healing, the pressure on the ulnar nerve is reduced, and the symptoms are resolved.

When conservative treatments such as medications, physical therapy, and steroid injections fail to alleviate symptoms, endoscopic cubital tunnel release is recommended. This procedure is suitable for individuals who experience persistent and intermittent tingling and numbness in the 4th and 5th fingers, a weak grip on the affected hand, a feeling of their fingers “falling asleep,” muscle weakness and impaired muscle function in the fingers, difficulty controlling fingers for specific tasks, tenderness and pain in the elbow joint, and sensitivity to cold temperatures.

Proper preparation is essential 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, anesthesia, 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 anesthesia 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

• After endoscopic cubital tunnel release surgery, you will be taken to the recovery area where your nurse will monitor your vital signs and observe you for any allergic or anesthetic reactions. Most patients will be discharged on the same day of the surgery, but some may need to stay overnight at the hospital. 
• You may experience pain, swelling and discomfort in the operated area. Pain medications and anti-inflammatory drugs will be given as needed. For the first few days, you will need to wear a sling and restrict your activities as instructed. Keeping your arm elevated above your chest while resting is recommended to prevent swelling and pain. Wearing a splint on your elbow for a couple of weeks will also aid in the healing process. 
• You are encouraged to gently exercise your fingers, elbow, and shoulder to prevent stiffness. Applying 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. A gradual increase in activities over some time is recommended. 
• The majority of 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.
• Endoscopic cubital tunnel release surgery has several benefits over traditional open cubital tunnel surgery. These benefits include a smaller incision, minimal muscle trauma, faster recovery, reduced postoperative pain, minimal scar tissue formation, and a lower risk of damage to adjacent nerves and blood vessels.
• Although endoscopic cubital tunnel release surgery is relatively safe, some risks and complications may occur, such as bleeding, anesthetic reactions, infection, nerve, vessel, or tendon damage, elbow instability, and persistence or recurrence of ulnar nerve-related symptoms such as pain, stiffness, numbness, or weakness. In some cases, additional surgery may be required.