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Split Decisions Prove Best for Elbows under Pressure

The simple act of bending the elbow is effortless for many people. But for others, bending and straightening the elbow can cause significant problems. When the elbow bends, the space for the nerves and blood vessels narrows, increasing pressure and strain on both. When decreased circulation and reduced oxygen occur long enough, a condition called cubital tunnel syndrome can develop.

Symptoms of numbness and tingling in the ring and small fingers may develop along with weakness of the hand. If nothing is done to reverse the poor blood supply to the nerves and reduce the pressure, these symptoms can become permanent.

There are several different surgeries to correct this problem. Unfortunately, surgery isn't always successful. Even when it is, the surgery itself can cause additional problems. Relieving one set of symptoms only to develop another is not a desirable outcome.

For this reason, doctors are looking at the timing of surgery for cubital tunnel syndrome. In the past, if the patient had symptoms but no signs of nerve damage, the surgery was delayed. Studies eventually proved that waiting too long could result in permanent nerve damage that doesn't improve with surgery.

One group of surgeons tried doing surgery when there were symptoms of numbness and tingling only. Nerve tests showed normal nerve function before surgery. Although the patient group was small (18 elbows), the results were good. This suggests that earlier surgery may be a good idea, even when nerve tests are normal. Seventeen of the 18 elbows regained normal elbow motion and grip strength. Numbness and tingling went away in all cases.

Early treatment for cubital tunnel syndrome is recommended when numbness and tingling in the hand signal possible nerve pressure. Even before nerves test positive for damage or injury, conservative care should be tried. If four to six weeks of physical therapy do not bring relief from symptoms, surgery is suggested. Releasing the pressure on the nerve without disturbing the nerve as it passes through the elbow may be all that is needed.

The goals of early surgery for cubital tunnel syndrome are to relieve symptoms; restore motion, strength, and sensation; and prevent worse symptoms. At least one study has shown that the right timing can accomplish all of these.

References: Matthew M. Tomaino, MD, et al. The Rationale for and Efficacy of Surgical Intervention for Electrodiagnostic-Negative Cubital Tunnel Syndrome. In The Journal of Hand Surgery. November 2001. Vol. 26A. No. 6. Pp. 1077-1081.

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