Cubital and Carpal Tunnel Syndrome

@feetnumb You asked, "How long will it take to get surgery?" That's a pretty broad question, and it really depends upon your location, surgeon's availability, facility availability, extent of each surgery, and whether each hand will be done separately.

What to expect? - As with any surgery, it may be described as "minor", but nothing is really so minor when it is your body being cut. Every one has underlying issues, different healing times, different tolerance for discomfort.
In general, rest, ice and elevate until the swelling subsides. No extensive water exposure until the incisions heal. You may need to loosen things up after being immobilized for a time. Finally, I was cautioned (many years ago) to keep good hand/wrist posture in mind so you don't have problems again.

Have you mad a decision about whether to have surgery?
Sue

I don't know anything about cubital carpal tunnel syndrome. I had carpal tunnel on my right wrist and went to Physical Therapy. I also bought a couple of splints - one for day and one for night. I was able to get rid of it without surgery.

I am an 81 YO male who has been diagnosed with both cubital and carpal tunnel syndrome.

The first and necessary step is to have a nerve conduction study done. I did.

The first highly rated surgeon I went to wanted to do both surgeries in two separate open procedures, one for each arm, under general anesthesia. I had told him I was terrified of general anesthesia and he essentially ignored me.

I went to my neurologist whom I completely trust. He reviewed the nerve conduction study (which incidentally had been performed by a very good retired Mayo neurologist) and noted that while the carpal tunnel was pretty severe, the cubital was described as "moderate" and he thought I could probably get away with just doing the carpal. He thinks very highly of the other top rated hand surgeon in greater Phoenix, Shelley Noland, at the Mayo Clinic and he referred me to her.

I had the same conversation with her and she agreed to do minimally invasive endoscopic carpal tunnel surgery on me. My worst hand was my non-dominant right hand and she did that one on August 31st. I am still in the recovery phase but I haven't had any problems on that side since the surgery. The cubital controls the top of the second to last finger and the last finger and I have not had any problems since the surgery in that regard. I am actually hoping I can work with my occupational therapist and avoid doing my dominant hand which I have as of now postponed to early December.

If you have a neurologist, ask her to do a nerve conduction study. If you don't, ask your internist/primary care provider to make a referral for you. That is your first step. No reputable hand surgeon would do any such work without such a study. Depending upon the results you might be treatable with non surgical methods (e.g., PT) or you might need surgery but might be able to avoid the cubital part like I am.

My second point is that you don't have to accept the proposed actions from the first surgeon you see. You can find another if you don't like his approach. I did and I am very glad I did.

@steveinarizona your reply certainly conveys how a symptom can be misinterpreted and you’re correct in that surgeons need to understand exactly where all the problems are before operating. There is another scenario that causes pain in the pinky and ring fingers; thoracic outlet syndrome. It is a compression syndrome between the collar bone and rib cage or between the scalene muscles on the side of the neck. It compresses both blood supply and nerves including the ulnar nerve which I think is also compressed by cubital tunnel syndrome when bending the elbow. This does make it confusing for doctors with overlapping symptoms that can affect the same nerve in different places. TOS is often treated with physical therapy and stretching and myofascial release. I have TOS, and often patients with this are misdiagnosed for several years. One test was the doctor listened to my pulse in my neck and when I turned my head, it stopped because of compression when the muscles tighten. TOS can be confused with carpal tunnel and I had both at the same time, and the surgeon for the carpal tunnel procedure accused me of malingering when his surgery didn’t fix the problem. My hands would turn blue or purple and get cold because of poor blood supply from TOS. Physical therapy and specifically myofascial release has helped me a lot.

Your surgeon may or may not be good as a cutter but he is certainly NOT good as a person. If something happens, blame the victim!

I am happy that you were able to get this done. Proper diagnosis (where the heck is Dr. House?) is critical and I am glad that you were able to eventually get this sorted out.

Having two conditions at the same time can really cause confusion. I have spinal and lumbar stenosis and for years it was not symptomatic (to the puzzlement of my neurologist). At the beginning of 2025 it suddenly became symptomatic radiating pain down both my legs. I went to neurosurgeon whom I did not like nor trust but he did agree that my first step should be a pain shot. So I found an excellent pain doctor and he ended up giving me an epidural steroid shot and the pain stopped radiating down my legs (sixteen months ago, fingers crossed). It was only then that I realized that my right knee had also failed but the pain from the stenosis had concealed the knee problem. A few months later I received a right total knee replacement and I have returned to playing golf and walking (I am an 81 YO male).

@steveinarizona I don't play golf, but my physical therapist indicated that the twisting during the golf shot has caused back problems for her patients. (Tiger Woods has had spine problems.) It seems one thing affects something else. If my pelvis shifts out of good alignment (from SI joint movement), it causes back pain on one side for me. I could see how a golf swing may add more to that if pelvis alignment is off. The misaligned pelvis also affects the knees, and I know if I get pain on the inside of my knee, that my pelvis has shifted a bit. I work to keep proper alignment by leveling my pelvis with some stretches and have orthotics in my shoes and according to my physical therapists, that helps prevent uneven wear and tear on joints. It's kind of like that old song, the hip bone's connected to the leg bone.....

As you said, one problem can conceal another. That hand surgeon who did my carpal tunnel surgery was not a good person. He had made a mistake in his records about which side was affected and refused to correct it saying medical records can't be changed. He even hid from me when I was at his front desk and had his staff tell me he was not there, but I had already seen him. I had to make an appointment to get him to speak to me after I came back with a diagnosis from another doctor that I had thoracic outlet syndrome. I asked him to send me to physical therapy and he refused. His excuse was he would not know if the PT was helping me or not and would not be able to judge if it was successful. Apparently, he did not like being called out for a medical mistake of a missed diagnosis. The surgery was fine. I showed him my hand that was blotchy purple with concerns about the circulation because it was cold and he took my pulse and told me I was fine.

Two comments.

1) A long time ago the only torque I had left in my swing had departed and moved to my car. So I don't put much stress on my stenosis laden back playing golf (and I don't hit the ball very far any more either).

2) Sue the bastard!

@steveinarizona Thanks for your support. That was a long time ago with the hand surgeon and it was better for me just to move on to a doctor who knew how to handle my issues. There wasn’t anything wrong with his carpal tunnel surgery, and it just wasn’t the whole story. To have merit in court case, there must have been harm done. It is hard to be the recipient of insensitive remarks from a physician that I trusted, but my best path forward was to advocate for myself to improve my quality of life. That is a victory of sorts when you choose to not allow someone to make you angry. Getting upset is allowing someone else to control your emotions. I don’t want to give a bully more power over me. This actually was a good lesson that served me well later when I was turned away by a series of 5 spine surgeons because they did not understand my symptoms. I wasn’t always a person who knew how to advocate for myself. It also helped me understand how to read the intentions of medical providers. It was at that time that I started getting my medical records and looking up everything I didn’t understand so I knew what they were thinking. I learned that doctors form opinions based on what patients tell them and can easily go down an alternate path and just refuse to help the patient. They look out for themselves. Of course there are doctors who excel at their career with empathy and compassion. I found them at Mayo when I became a spine patient there.