Subcutaneous vs. Submuscular Cubital Tunnel Surgery

There are four main types of cubital tunnel surgery:

  • Simple decompression – One of the cubital tunnel ligaments is cut to reduce pressure on the nerve, which remains in the tunnel.
  • Subcutaneous Transposition – The ulnar nerve is moved out of the cubital tunnel to the topside of the elbow.
  • Submuscular Transposition – The ulnar nerve is moved out of the cubital tunnel and placed underneath the muscles around the elbow.
  • Medial Epicondyle - The bony medial epicondyle on the elbow is shaved down so the ulnar nerve can shift freely in and out of the cubital tunnel.

Which Surgery is Preferred?

For mild cases of cubital tunnel syndrome (CuTS), simple decompression is often preferred because the incision is smaller, and recovery is faster.

But many analysts believe the ulnar nerve must be moved out of the cubital tunnel in order to heal properly, and therefore transposition surgery is better.

Transposition surgery is also recommended for medium-to-severe cases of CuTS and for subsequent operations on the same elbow.  This article compares the two types of transposition surgeries.

Subcutaneous Transposition

With subcutaneous transposition, the ulnar nerve is moved out of the cubital tunnel and placed below the subcutaneous fat of the arm and forearm.  A fascia flap is sutured to the overlying skin to maintain the transposed position.  (source)

Advantages:  Scar formation and subsequent compression is unlikely.  Location of the ulnar nerve is rich with blood vessels.

Complications:  Ulnar nerve is vulnerable to trauma, especially with skinny patients.

Submuscular Transposition

With submuscular transposition, the ulnar nerve is moved out of the cubital tunnel.  The arm and forearm muscles are cut, and the ulnar nerve is placed below them.  The muscles are then re-attached.  (source)

Advantages:  Places nerve in a good vascular bed that is relatively free from scarring.  Provides the most direct course from the arm to forearm for the ulnar nerve.

Complications:  Surgeon can injure the flexor-pronator muscles.  Patient can lose elbow flexibility.

Subcutaneous vs. Submuscular

Many studies including an important one by Jaddue, Saloo and Sayed-Noor show that subcutaneous transposition has a shorter incision than submuscular (12-14 cm vs. 15-20 cm), easier surgical technique and clamping measures, shorter operating time (≤ 30 minutes vs. ≥ 45 minutes), less postoperative pain, fewer postoperative infections, and earlier mobilization of the elbow.

Conclusion:  Every situation is unique, so you should consult with your doctor and possibly get a second opinion to decide which type of cubital tunnel surgery is best for you in your specific case. 

However, studies show that subcutaneous transposition is generally better than submuscular.  But both methods are effective solutions to cubital tunnel syndrome.

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Related posts:

  1. Study Shows Transposition Surgery Trending Better Than Decompression for Cubital Tunnel Syndrome
  2. Complications from Cubital Tunnel Surgery
  3. Study Questions Transposition Surgery for Cubital Tunnel Syndrome
  4. Preparation for Cubital Tunnel Surgery
  5. Recovery Time from Cubital Tunnel Surgery

Important: This website is for information purposes only and does not constitute medical advice. The information on this website represents the personal experience of cubital tunnel patients and has not been certified by medical professionals. Each person and case is different. Be sure to seek medical advice from a doctor with experience treating cubital tunnel syndrome and get a second opinion if needed.

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