On this page
Cubital tunnel release
Cubital tunnel release is a surgical procedure that relieves pressure on the ulnar nerve as it passes behind the elbow, treating numbness, tingling, or weakness in the ring and little fingers. By releasing or repositioning the nerve, the procedure reduces compression and allows symptoms to improve over time.
At a glance
Anaesthetic
General anaesthetic
Where
The Avenue Hospital
Day case or overnight
Day case
First post operative review
One to two weeks after surgery
Driving
Not for the first few days, and not until elbow movement is comfortable
Post Operative Hand Therapy
Routinely recommended
Splinting
A bandage dressing is usually all that is needed; splinting is not routinely required
Pain relief
Usually paracetamol and/or ibuprofen
Return to repetitive & heavy loading
Light activities within a few days; heavier elbow loading usually avoided for 2-4 weeks
Release of the ulnar nerve at the elbow (in-situ decompression)
Cubital tunnel release is surgery to relieve compression of the ulnar nerve at the elbow (cubital tunnel syndrome), which causes numbness and tingling in the ring and little fingers, and can cause weakness of the hand’s small muscles if longstanding. The nerve is released from the tight band of tissue compressing it, without moving it from its normal position (in-situ decompression).
Who is this procedure for?
- People with numbness or tingling in the ring and little fingers that persists despite activity modification and night splinting
- People with weakness of the hand's small muscles or clumsiness attributable to ulnar nerve compression
- People with confirmed mild or moderate ulnar nerve compression at the elbow on nerve conduction studies
- People whose nerve does not sublux (snap) out of its groove on elbow bending, making a simple release appropriate without the need for transposition
What does the surgery involve?
Surgery involves an incision behind the inside of the elbow to identify and release the tight band of tissue (the roof of the cubital tunnel) that is compressing the ulnar nerve, relieving pressure on the nerve along its course at the elbow. Unlike anterior transposition, the nerve is left in its normal anatomical position.
Alternatives to surgery
Simple release is one option for cubital tunnel syndrome. Depending on your situation, the alternatives may include:
- Non-surgical management: activity modification, night splinting to keep the elbow straight, and avoiding prolonged elbow flexion or leaning on the elbow, appropriate for mild or early symptoms
- Anterior transposition: moving the nerve to a new position in front of the elbow, generally reserved for more severe compression, a nerve that subluxes, or recurrent symptoms — see the separate page on this
What happens if left untreated: untreated, ongoing nerve compression can lead to progressive numbness of the ring and little fingers and weakness of the hand’s small muscles, which may not fully recover if compression is severe or prolonged.
Dr Tomlinson will discuss which options suit your specific situation at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves. Desk-based work is often possible within 1-2 weeks. Manual work or activities requiring repeated elbow bending may need to be modified for a couple of weeks. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for two weeks after the procedure.
When can I do a full day of administrative or desk work?
Often from 2 weeks after surgery, particularly with some temporary adjustments (see below). Taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during a general anaesthetic. In line with current ANZCA guidance you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication – your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
Splinting is not routinely required after a simple release. A light dressing protects the wound while it heals over the first week or two.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
Hand therapy is routinely recommended as part of your postoperatve rehabilitation.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Incomplete recovery of sensation or strength, particularly with longstanding or severe nerve compression before surgery
- Numbness or a tender scar from injury to a small sensory nerve (the medial antebrachial cutaneous nerve) near the incision
- Recurrent or persistent symptoms requiring further surgery
- Haematoma, uncommonly requiring drainage
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your elbow relatively still for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand may have numb areas during this time due to the local anaesthetic or post operative swelling, or due to the effects of pressure on the nerve prior to surgery. .
First week
Keep the dressing dry and intact until your post-operative review. When the outer bandage starts to slide down your forearm you can remove it. You may use your hand for light activities, but listen to your elbow and avoid anything that causes discomfort, such as lifting or gripping. Scar sensitivity and discomfort are expected in the first few weeks. You should find that your discomfort is slowly reducing.
Second week
The wound is usually settling well. Numbness and tingling may take some time to improve as the nerve recovers, and this is discussed with you before surgery.
6 weeks
Full grip strength may take several months to return, and deep-pressure tenderness over the wound can persist for some months.. The scar will feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle.
Long term
Nerve recovery after decompression can be gradual and, for longstanding or severe compression, may be incomplete. Most people are back to full activities within 2-4 weeks.
Want to know more about Cubital Tunnel Release?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.