Carpal & Cubital Tunnel Treatment

Carpal tunnel and cubital tunnel syndromes are common nerve conditions that affect the hands and upper extremities. Initial treatment of these conditions is nonsurgical, but surgery is available if more conservative treatments do not provide sufficient relief.

Dr. S. R. Brown is a board certified orthopaedic surgeon with additional subspecialty training in hand and upper extremity surgery. Dr. Brown specializes in both carpal and cubital tunnel surgery. She is also trained in endoscopic carpal tunnel release, a minimally invasive procedure that allows patients to get back to work sooner than open carpal tunnel release. Her practice is focused on hand and upper extremity surgery, and she has been in practice with Tennessee Orthopaedic Alliance since 2008.

What is Carpal Tunnel Syndrome?

The carpal tunnel is a narrow tunnel in the wrist formed by the wrist bones and the transverse carpal ligament. The median nerve, which supplies feeling in the thumb, index, middle, and ring finger, passes through the carpal tunnel. There are also nine flexor tendons that run through the carpal tunnel, which allow you to bend your fingers.

Carpal tunnel syndrome occurs when the carpal tunnel becomes narrowed due to swelling of the tendons or soft tissues in the wrist or thickening of the transverse carpal ligament. This can put pressure on the median nerve, causing pain, weakness, and numbness.

Common symptoms of carpal tunnel syndrome include:

• Numbness and tingling in the thumb, index, middle, and half of the ring finger
• Weakness in the hand, making it difficult to fine motor skills like buttoning a shirt
• Having your hands “fall asleep” while doing certain activities, like driving or brushing your teeth
• Frequently dropping things due to weakness in the hand

What is Cubital Tunnel Syndrome?

Similar to carpal tunnel syndrome, cubital tunnel syndrome is caused by nerve compression. However, cubital tunnel syndrome occurs in the elbow rather than the wrist.

The ulnar nerve, which supplies feeling to the little finger and half of the ring finger, runs through a tunnel of tissue in the elbow called the cubital tunnel. This tunnel runs along the inside of the elbow, under the medial epicondyle, a bony bump in the elbow that is often referred to as the “funny bone.” The ulnar nerve is close to the skin in this area, which is the reason you feel a shock-like pain when you bump your elbow.

Cubital tunnel syndrome occurs when the ulnar nerve becomes compressed at the elbow. This can be caused by keeping the elbow bent or leaning on it for long periods of time, frequently bending the elbow, swelling in the elbow, or a direct blow to the inside of the elbow.

Symptoms of cubital tunnel syndrome include:

• Numbness and tingling in the little finger and half of the ring finger
• Feeling the ring and little finger “fall asleep,” especially when the elbow is bent
• Weakness in the hand, making it more difficult to coordinate finger movement and perform certain activities like typing

Treatment Options for Carpal & Cubital Tunnel

Dr. Brown reviews X-rays, performs a physical examination, and may order EMG: electromyography (nerve conduction) tests to confirm the diagnosis of carpal and cubital tunnel syndromes.

Initial treatment for both carpal and cubital tunnel syndrome is nonsurgical. This may include over-the-counter or prescribed anti-inflammatory medications and wearing a brace or splint at night. At-home stretches may also be helpful. For carpal tunnel, cortisone injections may also be given to help reduce inflammation.

If carpal or cubital tunnel syndrome is affecting your life or work and conservative measures have not provided enough improvement, Dr. Brown can offer surgical options.

Carpal Tunnel Surgery

For carpal tunnel syndrome, the surgical procedure is called a carpal tunnel release. During this procedure, Dr. Brown makes a cut in the transverse carpal ligament, which increases the size of the tunnel and relieves pressure on the median nerve. Dr. Brown is trained in endoscopic carpal tunnel release, a minimally invasive procedure that allows for quicker recovery times so that patients can get back to work and normal activities sooner. For patients who are elderly or have a very severe case of carpal tunnel syndrome, open surgery may be necessary. Dr. Brown will advise which option is best based on the patient’s individual condition and physical examination and EMG results.

Dr. Brown performs both endoscopic and open carpal tunnel release surgery in an outpatient surgical facility, allowing patients to return home the same day. Patients undergoing endoscopic or open carpal tunnel surgery receive an axillary nerve block in the arm and sedation. They do not need to undergo general anesthesia for the procedure.

Cubital Tunnel Surgery

For cubital tunnel syndrome, Dr. Brown performs a cubital tunnel release as an open procedure. This is similar to a carpal tunnel release in that the ligament “roof” of the tunnel is cut to make room for the ulnar nerve.

Dr. Brown performs cubital tunnel surgery at an outpatient surgical center, and patients receive both an axillary nerve block in the arm and general anesthesia. They are able to return home the same day.

Recovering from Surgery

The recovery process for carpal and cubital tunnel surgery largely depends on the severity of the patient’s condition and the procedure itself. Dr. Brown provides specific post-surgical guidelines for each patient based on their needs.

Patients who have undergone endoscopic carpal tunnel surgery can begin using their hands for light daily activities the day after surgery. For all procedures, Dr. Brown may advise patients to wear a brace or splint for at least a few weeks. Patients are also given at-home exercises and stretches to aid in recovery. Most patients do not require formal physical or occupational therapy after surgery.

On average, patients are able to return to most normal activities within 4-6 weeks of surgery, though it can take as long as one year to see the full extent of improvement with nerve sensation and grip strength based on the initial severity of your symptoms.

Carpal & Cubital Tunnel Treatment in Murfreesboro, TN

As a fellowship trained hand and upper extremity surgeon, Dr. S. R. Brown is highly experienced in surgical procedures for both carpal and cubital tunnel syndromes. She is trained in the latest techniques in hand and upper extremity surgery, including endoscopic carpal tunnel release, a minimally invasive procedure that allows patients to get back to normal activities sooner. If you would like to schedule an appointment with Dr. Brown, please call our office (615) 896-6800 or use our appointment request form.