Endoscopic cubital tunnel release, or ECuTR, is a minimally invasive, promising, cutting-edge surgical technique devised to decompress the ulnar nerve as it passes through a tunnel called the cubital tunnel, which is located behind the bony bump on the inside of your elbow. The ulnar nerve supplies sensation to the ring and pinky fingers and the inner side of the forearm and hand. It also innervates many of the small muscles of the hand which are required for power grip and fine motor skills. Its compression will lead to numbness, weakness, and tingling in the respective areas.
Your surgeon will perform this surgery in:
- severe cases of ulnar nerve entrapment that fail to respond to conservative measures like anti-inflammatory pills, steroid shots, and ergonomic modifications, or
- cases where pinching of the ulnar nerve has led to extensive muscle weakness or damage
What is the procedure for ECuTR?
The surgeon first locates the bony bump on the inside of the elbow and then makes a small 2 centimeter incision behind it to approach the ulnar nerve coursing through the bony passageway called the cubital tunnel. Tools called retractors are passed through the incision to retract the superficially-located nerves from the ulnar nerve. The surgeon then inserts a thin tube called an endoscope that has a camera attached to properly inspect the ulnar nerve and the surrounding structures. The roof of the cubital tunnel is then divided to relieve pressure on the nerve. After decompression, the surgeon moves the elbow in different positions to assess the stability of the nerve. If the nerve remains stable behind the elbow’s bony bump during elbow movements, the surgeon will then end the procedure here and close the surgical incision with stitches.
Your surgeon will finally place the arm in a soft dressing, which is removed after 4 days.
How soon can your hand regain its function after surgery?
Most patients are able to return to work in about eight days and regain full function in four to six weeks.
What is the success rate of Endoscopic cubital tunnel release?
The success rate of the endoscopic technique varies from good to excellent in 80% to 94% of cases.
What are the risks associated with the ECuTR?
Some pain, numbness, and swelling may be present after the procedure, but severe complications are rare. The complications reported in the literature due to improperly performed technique include:
- Dislocation of the nerve to or past the bony bump on the inside of the elbow, causing pain and tingling in the pinky and little fingers
- Damage to the main branch of the ulnar nerve
- Collection of blood external to the blood vessel
What are the benefits of ECuTR over the open decompression?
The endoscopic approach provides a better view of the entire course of ulnar nerve both above and below the elbow, and hence, minimizes the chances of nerve damage. Being minimally invasive, ECuTR allows for a faster recovery with minimal scar tissue formation and reduced pain after surgery. Moreover, the endoscopic technique poses fewer potential risks and offers greater patient satisfaction.
Dr. Wayne Weil is a board-certified orthopedic surgeon with additional subspecialty fellowship training in elbow and hand surgery who is known for his expertise in hand and wrist surgeries. Contact Orthopedic Specialists of Seattle to schedule an appointment with Dr. Wayne Weil.