I’m supposed to have surgery for my elbow pain and hand numbness. The diagnosis is cubital tunnel syndrome. They are going to stick a needle into the area that has a tiny TV attached to it so the surgeon can see what’s going on in there. The plan is to cut any bands of tissue that might be pressing on or wrapped around the nerve. This poking around inside my body scares me. What do you think of it?

As you have probably been told, cubital tunnel syndrome is a condition that affects the ulnar nerve at the elbow. The ulnar nerve passes through the cubital tunnel just behind the inside edge of the elbow. The tunnel is formed by muscle, ligament, and bone.

The symptoms are very similar to the pain or electric shock sensation that comes from hitting your funny bone. When you hit your funny bone, you are actually hitting the ulnar nerve on the inside of the elbow. Numbness on the inside of the hand and in the ring and little fingers is an early sign of cubital tunnel syndrome. 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.

Treatment usually begins with conservative (nonoperative) care, which resolves the symptoms for many patients. But when symptoms persist and do not respond to splinting or stretching activities, then surgery may be needed. It sounds like this is where you are in your treatment. The surgeon has several choices when deciding how to do the surgery. The first is a local (called in situ) release of the structures pressing on the nerve. From your description, it’s likely this is the surgeon’s first intended step.

Surgery is much less invasive now that endoscopic techniques are available. With a very small incision, the surgeon can slip the scope in through the skin and soft tissues and find the nerve. It is possible to examine the position and condition of the nerve and assess any damage that may have occurred causing your symptoms. It’s a simple matter to then snip away any bands of fibrous, scar, or connective tissue that may be compressing the nerve.

Some surgeons are using a surgical approach to accomplish this type of decompression called the Hoffmann technique. The Hoffmann technique is an endoscopic approach from 10 centimeters (about four inches) below the elbow, releasing the nerve all the way up to 10 centimeters above the elbow.

The advantages of this surgical approach are that it enables the surgeon to look down on the nerve (and the soft tissues around it). Using the endoscope inserted into the forearm through the skin, the surgeon can have direct vision of the nerve. The ligament most often pressing on the nerve (arcuate or Osborne’s) is cut much like the in situ release. But the surgeon is also able to release other areas where the fascial bands (connective tissue) underneath the muscles are compressing or entrapping the nerve.

Not everyone is a good candidate for this surgical technique. But the Hoffmann technique can be considered for most patients who have not responded well to conservative care. No matter what method your surgeon has planned for you, if you are uncomfortable with what you’ve been told, take the time to visit with your surgeon and ask any questions you may have. This is an important step no matter what type of surgery patients are facing.