Nonsurgical Treatment Program
- Based on two ergonomic changes:
- Proper sleeping posture
- Correct daytime habits
Role of Therapists
Therapists teach patients ergonomically correct work habits. This involves adjusting the patients workstation configuration and recommending adaptive equipment to avoid direct pressure on the ulnar nerve and bending the elbow excessively. This works for most patients, but it takes about three months to demonstrate any improvement.
Surgery is recommended if:
- The measured nerve compression is severe enough
- Excessive nerve mobility exists involving subluxation on elbow flexion causing persistent symptoms
- All nonsurgical attempts have failed to resolve the symptoms
Most patients can be surgically treated for cubital tunnel syndrome with an in situ release of the nerve. This requires an incision that is less than one-inch long on the inside of the elbow.
Immediately after surgery patients are encouraged to use their arm and hand. One week after surgery, a home exercise program is begun. In the second week after surgery, the elbow sutures are removed and the patient can return to work.
Ulnar Nerve Transportation
This procedure transfers the ulnar nerve from its normal position into a healthy environment surrounded by a rich blood supply.
Ulnar nerve transportation is necessary under special circumstances:
- Ulnar nerve subluxation is present; the ulnar nerve is slipping in and out of its groove
- Patient has had a prior failed ulnar nerve surgery
Techniques of Ulnar Nerve Transportation
- Subcutaneously – Under the skin
- Intra-muscularly – In the muscle
- Sub-muscular – Beneath the first muscle layer of the flexor pronator mass
All types of ulnar nerve surgeries are performed as an outpatient procedure.
After surgery, a light soft dressing is placed over the wound. A therapist is normally consulted for postoperative rehab with an ulnar nerve transposition since this is a more extensive operation. An ulnar nerve transposition takes about three months for a patient to feel much better, whereas with the in situ release, the patient is close to normal within weeks to a month after surgery.