Freeing the Ulnar Nerve at the Elbow
Numbness in your ring and small fingers, especially when your elbow is bent, can make it hard to sleep, type or hold a phone. Cubital tunnel release can often correct the problem by freeing the ulnar nerve at the elbow so it can heal.
What Is Cubital Tunnel Release?
The ulnar nerve, often called the “funny bone” nerve, runs along the inside of the elbow through a narrow space called the cubital tunnel. In cubital tunnel syndrome, the nerve is squeezed or stretched there, causing numbness and tingling in the ring and small fingers, elbow pain and hand weakness.
Surgery relieves pressure on the nerve. Depending on what is found, it may involve:
- Cubital tunnel release: opening the band of tissue over the nerve to give it more room
- Ulnar nerve transposition: moving the nerve to the front of the elbow, so it isn’t stretched when the elbow bends. This is often used when the nerve slips out of place or is under tension.
Who Needs Cubital Tunnel Release?
- Numbness and tingling in the ring and small fingers that don’t improve with other treatment
- Hand weakness, clumsiness or trouble with fine movements
- Muscle wasting in the hand
- Nerve testing showing moderate or severe compression of the ulnar nerve
Treatments to Try First
- Avoid bending and leaning: don’t rest on your elbow, and avoid keeping it bent for long periods
- Night splint or padding: keeps the elbow straighter while you sleep
- Medications and therapy: anti-inflammatory medicines and nerve gliding exercises
When symptoms persist or weakness develops, surgery can often correct the problem.
How Cubital Tunnel Release Is Done
- Anesthesia: An outpatient procedure, usually under general anesthesia or a nerve block.
- Incision: An incision is made along the inside of the elbow.
- Releasing the nerve: The tissue compressing the ulnar nerve is opened along its course.
- Transposition, if needed: The nerve is moved to the front of the elbow and held in a new position.
- Closing: The incision is closed and a dressing is applied.
Watch Dr. Grunch explain cubital tunnel syndrome:
Video: Case Study 84, Cubital Tunnel Syndrome (Ulnar Neuropathy), presented by Dr. Grunch on her Ladyspinedoc channel (YouTube)
And another ulnar neuropathy case:
Video: Case Study 227, Ulnar Neuropathy, presented by Dr. Grunch on her Ladyspinedoc channel (YouTube)
Benefits and Risks
Benefits
- Relieves numbness, tingling and elbow pain
- Can stop weakness from getting worse and help hand strength return
- Usually a same-day outpatient surgery
Risks
- Numbness near the incision, which usually improves
- Infection or bleeding
- Elbow stiffness
- Symptoms that don’t fully resolve, especially with long-standing compression
- Risks related to anesthesia
Why Choose Dr. Betsy Grunch for Your Cubital Tunnel Release
- Duke-trained: Dr. Grunch completed her neurosurgical residency at Duke University School of Medicine, one of the top neurosurgery programs in the country.
- A nerve specialist: Neurosurgeons are trained in the entire nervous system, from the brain and spine to the nerves in the arms and legs. Dr. Grunch can tell whether your symptoms come from a pinched nerve in the neck or back or from a trapped nerve in the limb, so the right problem gets treated.
- The right operation: Dr. Grunch performs both simple release and ulnar nerve transposition, and chooses based on how your nerve behaves when your elbow bends.
- Experience you can count on: She has been in practice since 2013 and performs 400 to 600 surgeries a year, more than 5,000 procedures over her career.
- A teacher at heart: As “Ladyspinedoc,” she is known for explaining nerve and spine conditions clearly. You’ll leave your visit understanding your diagnosis and every option in front of you.
What to Expect
Before surgery
You’ll meet with Dr. Grunch or one of her physician assistants to review your symptoms, exam and nerve testing, and to decide together whether cubital tunnel release is right for you. Our team will review your medications (including blood thinners you may need to pause) and walk you through the day of surgery. You may have nerve testing (EMG and nerve conduction studies) to confirm where the nerve is trapped.
Procedure day
Surgery usually takes about an hour, and you go home the same day.
Recovery timeline
- First days: Keep the arm raised. Some soreness at the elbow is expected.
- Two weeks: Follow-up visit and removal of any stitches.
- Four to six weeks: No lifting with the operated arm during this time. Most people then return to normal activities.
- Up to a year: Nerves heal slowly. Numbness, tingling and occasional pain can come and go during this time, but your symptoms should not be worse than before surgery.
Caring for yourself at home
- Your incision: Your incision is closed with skin glue, and some have stitches that stay in until your follow-up visit. Remove the dressing on day two and shower once it’s off. Gently clean the incision and pat it dry without scrubbing. Leave it open to air, and don’t use ointments or creams. A small amount of brownish-red drainage for a few days is normal.
- No soaking: Don’t soak the incision in a bath, hot tub or pool for six weeks and until any scabs are gone.
- Swelling: For the first few days, raise your hand and arm above the level of your heart for about 30 minutes every two to three hours.
- Activity: Limit use of the operated elbow, and don’t lift with that arm for four to six weeks. You may use it to dress yourself and for self-care. Protect the incision from bumping or rubbing on hard surfaces.
- Medications: Take pain medication with food and avoid alcohol while taking it. Most people need it for up to two weeks. Take a daily stool softener and a laxative as needed. Don’t take blood thinners such as aspirin, warfarin, Xarelto or Plavix for five to seven days after surgery, until the office tells you to restart them.
- Driving: You may drive once you’re no longer taking narcotic pain medication. Riding as a passenger is fine.
- Smoking: Smoking slows healing. Our office can help if you’d like to quit.
- Follow-up: Your visit is about two weeks after surgery, when any stitches are removed. If you can’t work during recovery, our office can complete employer paperwork.
Call the office at 470-293-9800 if you have a fever over 101°F, redness, warmth or significant drainage from the incision, new weakness or numbness that wasn’t there before surgery, calf pain or swelling, or constipation that medication doesn’t relieve. Call 911 for chest pain or shortness of breath.
Download your patient instructions
Print these sheets or save them to your phone so you have them before and after surgery:
You’ll find instructions for other procedures on our Patient Resources page.
Frequently Asked Questions
Will the nerve need to be moved?
Not always. Many people need only a release. The nerve is moved (transposed) when it slips out of place or is stretched when the elbow bends.
How long until the numbness goes away?
Nerves heal slowly, and full recovery can take up to a year. Tingling often improves before strength does.
When can I go back to work?
Desk work is often possible within a week or two. Lifting with the operated arm should wait four to six weeks.
Is this the same as ulnar nerve compression at the wrist?
No. The ulnar nerve can also be trapped at the wrist, which is treated differently. Nerve testing shows where the problem is. Learn more about ulnar nerve compression.
Will I need a splint?
Most people don’t need a splint. Your surgical team will tell you if you do.
Take the Next Step
If numbness in your ring and small fingers is getting in the way of daily life, you don’t have to live with it. Whether you need a diagnosis, a treatment plan or a second opinion, Dr. Grunch and the Southern Neurosurgery team are here to help you understand your options.
Call 470-293-9800 to schedule an appointment or contact us online.
Have a question first? Ask our virtual assistant anything, 24/7.
We see patients across metro Atlanta and North Georgia at our offices in Gainesville, Sandy Springs and South Atlanta (Riverdale). Find the office nearest you.
Related pages: Cubital tunnel syndrome · Ulnar nerve compression · Carpal tunnel release · Peripheral nerve decompression
This page is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. If you have sudden weakness, numbness or loss of function, call 911 or go to the nearest emergency room.