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 Post-surgery driving instructions
After Surgery Instructions for Cubital Tunnel Syndrome
Cubital Tunnel Syndrome, or ulnar neuropathy of the elbow, is a common condition causing numbness in the small and ring fingers and weakness in the hand. If this condition does not respond to non-surgical treatment, or is severe enough, surgery may be indicated. The surgical procedure most often performed in our office is termed a medial epicondylectomy and cubital tunnel release. In this surgery, a portion of bone from the inside of the elbow is removed, taking tension off the ulnar nerve.
The surgery is usually performed as an outpatient surgery under general anesthesia. A plastic elbow splint is made before surgery by a therapist, and that splint is worn home from the hospital over a padded dressing.
1st Week:
- The plastic splint and dressing are worn full-time for the first week, and are not removed until the first post-surgical appointment in the office. The dressing needs to remain clean and dry, so plastic bags should be used to cover the extremity for showering.
- It is important to elevate the extremity as possible for the first 3 to 4 days after surgery. This means trying to keep the elbow between the ceiling and the heart. It is difficult to do this while walking, but the extremity can be placed on pillows while sitting down. For sleeping, the arm can be placed over a pillow on the chest, on pillows out to the side, or on pillows in front of you while sleeping on the opposite side. We do not recommend the use of slings, instead recommending that the shoulder be kept moving.
- In most cases, a local anesthetic will be injected into the operative area at the end of the surgery to provide pain relief for the trip home. This medicine usually lasts 8 hours, but has been known to last as long as several days in a few patients. Pain medicine will be prescribed, and should be used as needed. This is a narcotic medicine, so patients should not drive, operate machinery, or use alcohol while taking this medicine. The pain medicine should only be used as needed, and Tylenol or Advil can be used between doses, or instead of the pain medicine as pain resolves.
- Finger motion should be done periodically, trying to stretch the fingers and then bend them as far as the dressing allows. Light activity, such as picking up books or plates, is encouraged this first week.
- Ice can be applied over the operative area if needed because of discomfort. The ice should be kept in a plastic bag so that the dressing remains dry, but some of the cold will be able to penetrate the splint and dressing.
2nd Week:
- At the first post-surgical appointment, the padded dressing will be changed to a smaller dressing. This dressing can be changed as needed at home. The sutures will be left in place this 2nd week, but showering without a cover is permitted. The dressing can be removed before the shower, and the soap and water can run over the surgical site. The sutures should not be held underwater, such as in a bath or hot tub. After the shower, the sutures can be cleaned with peroxide or alcohol if desired, and a new dressing applied.
- The plastic splint is worn full-time during this week, except for showering. The splint will be modified in therapy to accommodate the smaller dressing. The elbow will move during showering, but exercises to regain motion will not be started until the 3rd week.
- Light activity with the splint in place is still encouraged. It is good to keep the fingers moving, and use the operated extremity for some activities.
3rd Week:
- Sutures are removed after the second week, at the second office appointment. 3 days after the sutures are out, a dressing is no longer needed, and the extremity can be soaked as in a bath or hot tub if desired. Also after 3 days, lotion should be massaged into the operative incision twice daily for 3 to 5 minutes. Any kind of hand lotion can be used, such as Vaseline intensive care lotion.
- During the next month, the plastic splint is gradually worn on a decreasing basis. The splint should be removed initially for lighter activities, and worn for heavier ones. The splint can be removed for sleeping and driving when the patient feels comfortable with that. Activities without the splint are increased gradually, with discomfort as a sign to slow down.
- Range of motion exercises should be done 2 or 3 times a day to regain motion of the elbow. The exercises should be gentle stretching exercises, not done fast or forcefully. Motion is usually returned to normal by 6 weeks after surgery.
- Strengthening exercises by squeezing a soft ball or grip strengthener can also be done 2 or 3 times a day.
Work Related Patients:
If the surgery is done under workman's compensation, work activities are restricted for the first 6 weeks in order to protect the surgical area, and avoid potential problems.
- For the 1st 2 weeks, the operated arm is not to be used at work. If the employer has one-handed work, that can be started 2 or 3 days after surgery as long as narcotic pain medicines are not being used. It is usually a good idea to establish before surgery whether your employer has one-handed work or not.
- At the 3rd week, light activity with the operated arm is started, but with the plastic splint in place. This eliminates elbow motion at work, and a lifting restriction is also utilized. Impact tools such as screw guns are restricted.
- Full work without restriction is usually started at the 6th week after surgery.
If you have problems or questions, please call the office for help. Whenever possible, call during normal business hours (8 AM to 5PM, Monday through Friday).
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