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The Truth about Cubital Tunnel Release Surgery

cubital tunnel release surgery

If you’re contemplating having cubital tunnel release surgery, let’s go into the truth about what to expect after that surgery. 

My name is Hoang, I’m an occupational therapist and certified hand therapist. And I’ve treated hundreds of people with cubital tunnel release surgeries, and, also, help them avoid it as well.

What is Cubital Tunnel Surgery?

Cubital tunnel surgery is a surgical intervention designed to release pressure on the ulnar nerve at the elbow. The ulnar nerve is responsible for transmitting electrical signals between the brain and the hand, and when it becomes compressed or impinged, it can result in various uncomfortable and often debilitating symptoms. The surgery aims to alleviate these symptoms by creating more space for the nerve and reducing the pressure on it.

Indications for Surgery

Cubital tunnel surgery is not the first line of treatment for cubital tunnel syndrome. Before considering surgery, healthcare providers typically recommend non-surgical approaches to manage the condition. These non-surgical options include:

Rest and Splinting: Giving the elbow a break and using a splint to keep it extended.

Physical Therapy: Exercises to strengthen and stretch the affected area.

Medication: Pain relievers and anti-inflammatory drugs to reduce discomfort.

Lifestyle Modifications: Changing habits that may be contributing to the condition, such as avoiding prolonged elbow flexion.

The truth about Cubital Tunnel Release Surgery 

So, here is the truth about what to expect after the surgery. And then, I’ll also share with you my perspective about what you can do to avoid it if that’s something you’re interested in. So, when it comes to cubital tunnel release, I’m gonna just talk about the most simple procedure because there’s several different procedures depending on what you need. But I’m gonna talk about the most simple one.

The most simple one is, basically, if your nerve is being choked and compressed, and is being choked and compressed. So, here are the two bones that that ulnar nerve sits along, And we have various types of connective tissue that just hold it in place. And you’re supposed to be able to bend your elbow and move, and that nerve is supposed to kinda shimmy a little bit as it gets moved through that tunnel, 

So, when it comes to having a surgical release, all they do is say go in, and they slice away those bands, those restrictive fibers that, like, hold everything so it’s almost like you get a release. Imagine if you at Thanksgiving, overate and you’re wearing jeans, you unbutton your jeans, and you’re like, “A h,” So, that is pretty much like cubital tunnel release, they’re just unbuttoning those tight little pants, and, now, your nerve gets to breathe and glide a little bit more freely.

The great thing about cubital tunnel release is that you really don’t have precautions afterwards. Meaning…well, you didn’t break a bone so you don’t have to stop moving, you didn’t cut a muscle or a tendon so it doesn’t stop you from moving. You didn’t cut the nerve so it’s not gonna stop you from moving. All it did is sort of release how tight it is.

So, that, usually, means that you’re allowed to do a lot of stuff. You’re allowed to do movements, you’re allowed to move. The thing is they just want to be real gentle at the beginning. So, at the beginning, you’re gonna have this bulky dressing, it’s gonna be real thick and it’s gonna stop you from, essentially, bending all the way. And that just allows that scar…

So, you’re gonna have a little scar, depending on your surgeon how long that scar is. And it also depends on how much compression you have that they had to kinda cut and release. But, usually, it can be…you know, some surgeons do a really small incision, and some surgeons do a really big incision just depending on your surgeon. But it doesn’t matter how big or how small it’s still gonna hurt a little bit.

So, that’s just what happens when you have surgery, there’s gonna be a certain amount of pain. And you’re gonna feel like every time you straighten out, your skin is gonna squish, So, it’s gonna hurt because it gets squished. And then, every time you bend your elbow, it’s gonna stretch so you’re gonna feel the tension of the stretch. Technically speaking, you’re allowed to move and you just wanna move real gentle, You don’t wanna take your arm and pull and push it.

One thing I do is, I teach my patients to move real gentle is using gravity to help you. So, if you’re lying down, so pretend like you’re laying down in bed, all you do is you bring your shoulder up, and then you can gently let gravity bring your arm down and have it touch your head. If it touches your head, it’s bending a certain way, And then, you can bend it to touch your nose, and then your chin, and then, eventually, to your ear. And that’s gonna just slowly bend your elbow and it’s gonna stretch out your skin. And then when you’re lying down, you can just let gravity pull it straight.

So, that’s just one easy way of just slowly gently moving it. You wanna do that gentle, slow-moving for the first two weeks because your incision needs to heal for two weeks, Usually, when they cut the cells of the cut starts to come and they’re, you know, sowed together, But those stitches, take about 10, you know, to 14 days to fully heal and your skin takes about 10 to 14 days to fully come together.

And then, once your incision is healed, then you can move as much as you want, as much as you want. And, also, as much as pain allows you to tolerate. So, the first few days they’ll, probably, tell you not to get it wet so that the incision gets a chance to heal, usually, about five days.

And then, you’re probably going back to your surgeon to do what’s called the post-op check so between five to seven days. And then, they’re gonna go and they’re gonna change your dressing and everything looks great and dandy and, you know, you have circulation, you have… The way I tell my patients that, you know, the surgery was successful, and you wanna know, essentially, right away is most people go in because they have numbness and tingling.

So, if the compression is causing that numbness and tingling, as soon as they decompress it, it’s like unbuttoning the pants, You can breathe, well, so that’s the same with your nerves. So, you should feel that numbness go away right away. And that’s how you know, like, man, that was pretty successful surgery.

Then you’re just waiting for the incision to heal. And then, by the two weeks, you can, you know, once it’s healed, you can massage it. So, I tell my patients you don’t have to be really aggressive with the massaging. This isn’t a very sensitive area of our skin, like, on the outside of your elbow your skin and your tissue is a little rougher, it handles a lot more. On the inside is a little bit more sensitive, the skin is softer, the skin is thinner, essentially.

So, once your incision is healed, you can do what’s called scar massage, Or if you feel like you’re really swollen there, you can massage it to help with the swelling. And all I do is I put a little bit of cream, a little bit of lotion. Cream is nice because it lasts, like, you can massage longer because it’s got, like, a little bit of oil in it. Versus lotion should be water-based. So, the first ingredient is water and it just gets absorbed into your skin faster.

So, there’s no right or wrong, use what you have. And you can put a little bit on and you can just start massaging, And you could come downward, you can come downward. And then, you can also come across that scar, 

And I always tell people, like, when I teach my patients, don’t just stay where the scar is, don’t just run the shit out of the scar just because it’s there go around it too. Because, just because they cut you there doesn’t mean that area surrounding it is not affected, of course, it’s affected. So, you can work that whole area. So, you take the whole hand, and you just…you can work the whole area.

And then, remember your skin moves in every direction so it’s not just up and down, it’s side to side as well. So, you can, essentially, move your skin from side to side. And I always say, like, you know, your elbow, it has this extra skin, And it has this extra skin because every time you bend it, it has to stretch all the way out. So, what happens is it can get really tight, and so you can definitely massage that. It’s all just skin and fascia underneath.

So, you wanna take it, and you can pull it down and massage it, like, going down, you can go up, you can go to the side, you can go to the other side, whichever feels good. Just gonna loosen up the scar, it’s going to loosen up the skin, and loosen up the fascia underneath. It’s just gonna make it so that it’s easier for you to move.

And then, after the first two weeks, then the second two weeks, you can make sure that you’re moving it better. And with the elbow, the elbow gets really tricky because it doesn’t want to always be straight. So, if you think about it your elbow, natural cadence of your elbow, when you’re just standing has a slight bend to it,This is natural, this isn’t everybody. Nobody is standing like this. Nobody is walking like this.

There’s an episode of “Seinfeld” that makes fun of people walking like this because no one does that. So, what happens is when you have surgery of your elbow, sometimes you can get really tight, trying to get that last a little bit. So, I always tell people hold behind your elbow, and try to get the last little bit of what we call elbow extension to make it go all the way straight.

So, if you can take a look at my elbows, I have what’s called hyperextension. So, my elbows go beyond, goes beyond zero. Like this is zero, my elbow goes beyond zero. So, if you’re like me and you’re loosey-goosey and your elbow goes beyond zero, you wanna get beyond zero so that you can get back to what your body’s normal is. And then, you wanna be able to bend it,

And during these last two weeks, you wanna get as much a full, full, full motion as possible. So, I should be able to bend my elbow, push on my elbow and it didn’t hurt, that’s what you want. If you want full recovery, you have to get full motion that’s it.

The truth about cubital tunnel release surgery is that you don’t have any precautions. And if this cubital tunnel release is your only problem, there should be no reason why you’re not getting 100% recovery from this, If it’s at the elbow, and you had the surgery, you know, just to your elbow. This is different if you have a cubital tunnel release due to other injuries of your elbow.

So, people, you know, I’ve worked with people with some of the worse, you know, fractures and injuries to the elbow. And because of their bony structures and the fractures and stuff like that, their cubicle, you know, their ulnar nerve gets restricted and compressed. That’s a whole different recommendation because it depends on the severity of the cubital tunnel, like the ulnar nerve compression, and, also, depends on the severity of the fracture.

So, the truth about cubital tunnel release is, I’m talking about the most simple release and the most simple chronic issue, That there should be no reason why you’re not able to get 100% recovery and get full motion.

If you’re not able to get it within the first month, get professional help, If you’re overly sensitive, if your nerve is still irritated, get professional help because if you’re too aggressive with the nerve, it’s gonna get irritated. If there’s other problems along that nerve because remember the ulnar nerve comes out of the neck down the shoulder and down the elbow, down the wrist.

So, if you’re irritated, so after a month’s time and you haven’t gotten that full recovery, I do recommend getting professional help to find out, like, what’s causing that, you know. Because the truth of our cubital tunnel is that a lot of times…I think that everyone could benefit from, like, one or two sessions, But sometimes surgeons, because it’s a relatively easy surgery, most surgeons are like, “Because it’s an easy surgery, you can recover on your own,” 

But truth is not everyone can recover on your own. If you do what I’m telling you to do, it’s the first two weeks of gentle motion. The second two weeks to get more motion, and to work on your scar and your swelling. And if you’re able to do that on your own, then do that on your own. But if after a month you’re still having issues, don’t wait, and wait, and wait because a stiff elbow becomes a very difficult thing to work through, Then it takes longer and it takes more therapy.

So, it, usually, doesn’t happen, but I believe in a bell curve. And there’s always about 20% of people who have a cubital tunnel release that just ends up having more issues than majority of the people, But that’s, sometimes, that’s people’s bodies recovery. And, you know, don’t be so hard on yourself and just get, you know, go into a trusted occupational therapist certified hand therapist, and get the help that you need so that you can get 100% recovery, 

Now, the truth about cubital tunnel release surgery too is that you can, actually, avoid the surgery, you can. I’ve worked with enough people to know it’s possible to avoid the surgery. And it always depends on, you know, like, when you come in for the actual help.

And so, here’s the two things that I look for when I’m talking to people who, potentially, are gonna work with me. I tell my patients, “One, one thing that we’re looking for in therapy is can we reduce your symptoms, “Can we reduce your symptoms? The second thing, that we’re looking for is, can we keep it?” Because we should be able to see relatively quickly if you have a simple cubital tunnel type of issue. And we look throughout the whole arm, and I’m not, like, only looking at your elbow. I’m looking at the whole arm and say, “Okay, where, potentially, is that problem?”

And I say, “Okay, well, based on what I see today, I can help you.” We’re gonna look for two things, we’re gonna look for can we get rid of your symptoms, And that should be x, y, and z depending on your severity. And what you’re willing to do to work together, And the second thing we’re looking for is can we keep it, If we get the symptoms, then we’re looking for, you know, how long can we keep those symptoms.

I think a lot of times people when they’re dealing with injuries, they get to about 75, 80% because the reduction in pain symptoms. And then, all of a sudden, because you already feel a certain amount of good, you stop working to get the 100% and sometimes there can be a little backsliding. So, it’s not that you can’t keep, it’s just that there’s certain amount that you have to keep walking until you resolve the problem completely. You know what I mean?

So, yes. So, that’s, essentially, what you can expect after a cubital tunnel release, it’s very safe, you know, it can be a quick recovery. But the truth is, is that you can also avoid it. And if you’re interested in looking in terms of avoiding it, and you’re in the local Miami area, my name is Hoang Tran, I’m an occupational therapist and a certified hand therapist. And I have my clinic here in Miami, Florida called Hands On Therapy Services.

Conclusion

And if you’re having some of these cubital tunnel types of issues, numbness, pain in your hand, give us a call and see how we can help you. If you’re not in the local Miami area, I hope this video gives you some insight into what you can do to, one, what to expect from the surgery. Two, know what to look for if you’re trying to avoid the surgery. And just look in your local area and find a trusted occupational therapist or certified hand therapist that can help you.

CLICK HERE! to watch the YT video

About Hoang Tran – an expert in physical & occupational therapy  

Hoang Tran is a Miami certified hand therapist , the owner of Hands-on Therapy Services and the author of the book “The Hands-On Approach”. She loves helping people with hand, neck and shoulder problems because she knows how bad and debilitating they can get if not addressed and treated properly (once and for all!). 

The aim of her occupational therapy practice is to bring patients back to full functionality, without pills, injections or surgery. Occupational and Physical Therapy are both offered at Hands-On Therapy by our experienced therapists who provide a comprehensive approach to your care. 

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