Due to ongoing problems of cubital tunnel syndrome, my doctor is suggesting surgery. What does surgery for this problem usually involve?

Doctors use two different methods to correct problems of cubital tunnel syndrome. The first, called ulnar nerve transposition, is done by forming a new tunnel using the flexor muscles of the forearm. As the name implies, the nerve is actually moved (transposed) into the new tunnel.


A second procedure is done by taking the bump off the inside edge of the elbow, the medial epicondyle.  Doctors call this procedure medial epicondylectomy (“ectomy” means to remove). This keeps the ulnar nerve from hitting the bump and allows it to slide easily through the cubital tunnel.

I am having arthroscopy for tennis elbow. Will I be able to go back to sports after surgery?

If your results are as good as those in a recent study, you shouldn’t have any problems getting back to sports. All 12 patients included in the study were eventually able to return to sports, with the exception of a 70-year-old man whose symptoms had lasted for 20 years before surgery.


You’ll want to take it easy for at least a little while after surgery. Talk with your doctor or physical therapist about how to return to activities while ensuring a good recovery.

I am having arthroscopy for tennis elbow. How soon will I be able to go back to work after surgery?

If your results are as good as those in a recent study, you’ll be back to work in no time. For the 16 patients in this study, most of whom had desk jobs, the average time before returning to work was six days. One 49-year-old woman was even able to work from home on the day of surgery. If you’re in manual labor, it may take a little longer to get back on the job. The only patient in manual labor in this study took a month off after surgery.


You’ll want to take it easy for at least a little while after surgery. Talk with your doctor or physical therapist about how to return to activities while ensuring a good recovery.

I’ve tried conservative treatment for tennis elbow, but it hasn’t helped. My doctor says surgery’s the next step. He wants me to have an arthroscopic procedure. What’s that?

This procedure uses a special instrument, an arthroscope, that allows doctors to see inside the elbow joint without making long incisions. This “closed procedure” reduces the risks of surgery, such as infection and the development of scar tissue. It also appears to be very effective in getting rid of patients’ symptoms.


With arthroscopy, doctors can remove the lesions that cause tennis elbow. They can also identify any other related problems that may be causing symptoms.


A recent study of 16 patients showed excellent results from this procedure. None of the patients had complications from surgery. And none needed to have more surgery. Ten of the 12 patients asked said they felt much better from surgery, and none said they felt the same or worse.


Arthroscopy seems to be a safe, reliable way to relieve the symptoms associated with tennis elbow. Be sure to talk with your doctor about any questions you have and why he or she thinks this procedure is the best choice for you.



 

I need to have surgery for tennis elbow. My doctor says there are “open” and “closed” ways to do the surgery. What’s the difference?

In open surgery, doctors make incisions in the skin to do the procedure. This allows them to open the tissues and see more of the elbow area. It may also increase the risk of problems from surgery, such as infection and the development of scar tissue.


In closed surgery, doctors use special devices to operate through the skin with much smaller incisions. This reduces the chance of infection. It also reduces the time to heal. Disadvantages include the possibility that doctors won’t be able to see well enough inside the joint to fix the problem.


A recent study tested this type of surgery for tennis elbow. Doctors used an arthroscope, a miniature TV camera inserted into the joint through a small incision.


For the small number of patients tested, this procedure gave excellent results with no complications. Doctors were able to fully remove the lesions that caused elbow soreness. They were also able to identify other problems that may have added to patients’ symptoms.


There are advantages to both open and closed procedures. Talk to your doctor about which method he or she prefers in your case.

I’ve had pain along the outside of my elbow for a while. I’ve tried physical therapy in the past. My new doctor wants me to wear a brace and do physical therapy again. He thinks these things will keep me from needing surgery. Is he right?

Research shows that people with this condition–commonly known as tennis elbow–are twice as likely to need surgery if they’ve already tried bracing and physical therapy without success for their sore elbow.


A recent study looked at 97 patients with tennis elbow. Thirty-eight percent of the patients who had already been treated for elbow pain wound up having surgery, versus 19 percent of those who had not.


Still, 62 percent of the patients who had been treated before didn’t have surgery. So there’s some chance that bracing and physical therapy will give you better results the second time around.


If you want to give nonoperative treatment another try, talk with your doctor about what’s expected and how long you’ll need to continue before other options are considered.

When it comes to tennis elbow, do steroid injections become less helpful the more of them you have?

The more chronic a patient’s pain, the more likely he or she is to need more intensive treatment, such as injections or surgery.


A recent study showed that the benefits of steroid injections decreased with the number of injections patients had. Patients who got relief after one injection avoided elbow surgery 88 percent of the time. But patients who had three injections avoided surgery only 22 percent of the time.


Steroid injections can help reduce pain and swelling when tennis elbow is fairly new. The benefits tend to decrease with time, even when additional injections are given. Patients should talk with their doctor before having more than one injection.

Could my age-old problem with golfer’s elbow be causing numbness in my hand?

Not likely. Golfer’s elbow mainly causes pain on the inside bump of the elbow, the medial epicondyle. In severe cases, the pain may spread into the forearm. The fact that you feel numbness in your hand suggests there is more going on than golfer’s elbow. Given the location of the ulnar nerve behind the medial epicondyle, along with your long history of golfer’s elbow, your symptoms may be from a condition called cubital tunnel syndrome.


An early sign of cubital tunnel syndrome includes numbness on the inside of the hand and in the ring and little fingers. The numbness is often felt when the elbows are bent for long periods, such as when talking on the phone or while sleeping. The hand and thumb may also become clumsy as the muscles become affected.


Keep in mind, however, that hand numbness can occur for a variety of reasons. It can even be from a nerve problem where the nerves originate in the neck. Your doctor’s examination can help locate where your problem is coming from.

Whenever I bend my elbow, I feel a snap on the inside edge of the elbow. Could this be related to the numbness I feel in my hand?

The two may be related. The ulnar nerve runs through a tunnel behind the inside bump of the elbow, the medial epicondyle. This nerve passage is called the cubital tunnel. As the elbow bends, the ulnar nerve stretches. Sometimes the nerve will shift or even snap over the medial epicondyle. If the nerve has become irritated, it can cause numbness on the inside edge of the hand, including the ring and little fingers.


Keep in mind, however, that hand numbness can occur for a variety of reasons. The ulnar nerve can be pinched in places other than the cubital tunnel, for example, in the wrist. Numbness in the hand can even come from a nerve problem where the nerves originate in the neck. Your doctor’s examination can help locate where your problem is coming from. 

I’ve had pain in my elbow for years. Since getting treatment for it, I’ve heard my doctor and occupational therapist talk about the “carrying angle” of the elbow. What is so important about this angle, and are there differences in the elbow angles of males and females?

Imagine carrying a bucket with your arm at your side and your palm facing forward. In this position there is a slight outward bend at the elbow, the “carrying angle.” Normally there is about a five to fifteen degree outward bend, five degrees for males and ten to fifteen degrees for females.


When examining the elbow, health providers check to see if there is too much or too little bend in the carrying angle. They also note if the angles are the same on each side. If problems with the elbow cause it to angle too far in one direction, these can put extra strain on the elbow and may play a role in elbow pain.