Hi there. I've been a cubital tunnel patient for 9 months so far and would like to offer my "if I knew then what I know now" advice about choosing between the release and transposition surgeries.

I was diagnosed with cubital tunnel in both elbows last May 09. I tried conservative therapy for a couple months with minimal relief. I finally decided that surgery was the answer. My PA encouraged me to go all the way with the transposition. However, my MD was more conservative and suggested the release. I was overwhelmed with the decision. I was very scared of surgery and wanted to be as conservative as I could be. So, I left the decision up to my MD who decided intraoperatively to try the release first on my left arm. After 2 months of therapy, there was no improvement to the nerve. I chose the transposition on the right arm and then had a third surgery to transpose the left nerve.

As a patient, I typically choose the most conservative option. But at this point, if I could do it all over again, I would listen to my PA and opt for the submuscular transposition. Yes it is more invasive, painful and requires more rehab, but I'd say if you are going to through surgery and months of therapy, might as well only do it once.

I have my theories as to why the release didn't work. I feel that the physical therapy and scar massage methods are irritating to the nerve. My left arm showed lots of re-scarring on the nerve when they went back in. Also, I had this sinking feeling that the release would not be a permanent solution. The nerve remains in the vulnerable bend of your elbow and is succeptable to reinjury. By getting the transposition, I don't have anxiety about leaning on my elbows or doing yoga or any of those other behavior modifications that we cubital tunnel patients have to make. Also my arms have the tendency to hyper extend which causes ulnar nerve tension which is only relieved by transposition.

So those are my two cents. As always, please listen to your doctor's advise above mine, as your case may be different. I'm currently couch bound recovering from surgery #3, so if you have any questions, I have plenty of time to answer them Good luck to you.

Both of the Doctors I saw immediately said Transposition. After doing my own research I decided that the release didn't seem like a answer for me. So I would agree with you. So thanks for the pennies.

So how are you doing? When was your surgery? How is the pain in the arm that was already done? Are you cured? I hope so Thanks so much Cynthia

Hi

Thanks for this post, it has put my mind at rest somewhat. Originally my consultant was talking about doing a Medial Epicondylectomy, but he decided that the best course of action for me would be transposition first in my left arm and then in my right. I was fairly unsure about the decision given the extra recovery time etc. I have subluxating ulnar nerves in both arms and have been in a lot of pain for a couple of years now.

He didn't however tell me which version of the transposition he intends to do: Subcutaneously, Intramuscularly or Submuscularly (and i didn;t know there was more than on way until researching it). Do you have an opinion on which is best, or even what the main differences are/reasons for having one over another? I can't seem to find this info on the internet.

Other questions i have (if you don't mind - or if anyone else feels like sharing!!):
- Did you have to have a drain?
- Did you have disolvable stitches?
- What was the pain like when you woke up?
- what pain medication did you get to take home with you?
- What bandaging did you have?
- How long did you have to wait between surgeries for each arm?

I will ask my consultant to confirm which type of transposition he intends to do. As you can probably tell i'm rather nervous about the whole thing as I have never had surgery before and two weeks out i'm already starting to panic!!

Thanks for any advice you can offer, being an expert by now!

Cheers

Andrew

Thanks for reading my post. To answer your questions, Cynthia, my surgeries were 08/31/09, 11/02/09 and this past Saturday, 02/13/10. My main symptoms were stabbing and burning in the elbows and aching in my pinkies. I would say that I noticed these symptoms were gone as soon as the surgical pain had faded, maybe 2-4 weeks post transposition.

I do have some sharp pain at the scar sight now, which can be scar tissue or internal stitches. I was also feeling some mild burning on the inside of my forearm (what the PA tells me is the nerve waking up), but that is mostly gone by now, and only shows up i I type a lot. I haven't resumed full blow physical activity, aka yoga and resistance training, yet but don't anticipate any problems once I do. 3 months post surg, I feel about 90% cured on my right side.

Best of luck to you

Andrew,
Sorry to hear you have to get surgery for your bilateral cubital tunnel. I go to a major University Medical center in Chicago and they are fairly progressive with their treatment. They do not offer the Epicondylectomy, and I never read much that thrilled me about this surgery. My MD suggested the submuscular for me because I didn't have a lot of "padding", and I'm a average sized girl. I did get a second opinion from another MD who suggested subQ, so I almost feel that the surgeon suggests whatever they're more experienced at But don't let that sway you- get the surgery you want!

I agree, there is not a very concise source of info that explains the differences between the surgeries and which one to get. That's because there is currently no "right" answer. Doctors don't really have strong predictors for who responds to which surgery. My MD said there was a 50/50 chance that the release would help. Obviously it didn't. My PA said that a lot of patients were showing short term relief from release and then relapsing. But I have yet to hear/read about someone who was "cured" by the release...and please correct me if I'm wrong. There may be someone on this forum who has.

To answer your other questions:
1) I didn't need a drain either time, but it was a potential both times
2) I had dissolvable stitches
3) I had a nerve block which numbed my entire arm so I actually felt nothing when I woke up (which is awesome). The pain in the first three days is the worst so keep it iced and elevated as much as possible. Pain is about a 5-7/10, but can be managed with drugs and ice. Make a soft fist every so often so your hand doesnt swell too much.
4) I took Norco which took away the pain but makes me feel sick like I was hungover..headache, nauseous. Second time I tried Nucynta- a new drug. It doesnt work as well on pain, but it doesnt make me sick. If your drug doesnt work, ask for another.
5) I have a partial cast which is wrapped in an ace bandage, so its unremovable.
6) I had to wait 3 months between surgeries.

Good luck to you. I too was very nervous about surgery...all three times That's expected when they are rewiring your arm! I hope you can find some time to relax before your surgeries. It does sucks to have to go through this but it is worth it to get your arms back to full use. Please don't hesitate to ask me any more questions you may come up with.

Jill

Hi Jill

Thanks a lot for your reply, it really helped put my mind at rest. I have contacted my surgeon to ask which version of the operation he intends to do, but no reply as of yet. My biggest concern really is waking up in pain after the operation, i'm not sure why this is bothering me so much!

My doctor has now put me on slow release morphine and oral morphine to control the pain in my arms/hands so hopefully that will be enough to control the post-operative pain as well.

10 days to surgery, wish i didn't have to wait

Andrew