What is the recommended duration for splinting after a cubital tunnel decompression and anterior transposition of the ulnar nerve?

Postoperative Splinting Duration After Cubital Tunnel Decompression with Anterior Transposition

Splinting should be maintained for approximately 2-4 weeks following cubital tunnel decompression with anterior transposition of the ulnar nerve, with early protected mobilization beginning around 2 weeks postoperatively.

Evidence-Based Splinting Protocol

Initial Immobilization Period (0-2 Weeks)

• Rigid immobilization is recommended during the first 2 weeks postoperatively to protect the surgical site and transposed nerve 1
• The elbow should be positioned at approximately 45° of flexion during immobilization to minimize tension on the ulnar nerve 2
• This initial period allows for wound healing and reduces the risk of nerve displacement from its new anatomical position

Transition Phase (2-4 Weeks)

• Protected mobilization should begin by 2-4 weeks postoperatively to prevent elbow stiffness while maintaining nerve protection 1
• A removable splint or modified protective device that limits extreme flexion may be used during this transition period 1
• Early motion is critical to prevent joint contracture, which can significantly impair functional recovery

Key Considerations for Splinting Duration

Factors favoring shorter immobilization (closer to 2 weeks):

• Uncomplicated primary surgery with stable nerve transposition 3
• Younger patients with good tissue quality 4
• Absence of significant intraoperative findings requiring extended protection

Factors favoring longer immobilization (closer to 4 weeks):

• Revision surgery or multiple previous procedures, which are associated with poorer outcomes 4
• Older patients (age >60 years) who may have slower healing 4
• Significant nerve scarring or compression requiring extensive release 3

Common Pitfalls to Avoid

• Prolonged immobilization beyond 4 weeks can lead to severe elbow stiffness that may require extensive physical therapy and potentially compromise functional outcomes 1
• Inadequate initial protection (less than 2 weeks) risks nerve displacement or wound complications, particularly if the patient is non-compliant 2
• Failure to transition to protected mobilization by 4 weeks can result in permanent range of motion deficits 1

Postoperative Rehabilitation Timeline

• Weeks 0-2: Rigid splinting with elbow at 45° flexion, wound care, and edema control 2
• Weeks 2-4: Transition to removable splint with gentle active range of motion exercises 1
• Weeks 4-6: Progressive strengthening and functional activities as tolerated 3
• Return to work: Average 28 days for manual laborers, though this varies based on occupation demands 5

Clinical Monitoring During Splinting Period

• Assess for signs of nerve compression including increasing pain, numbness, or motor weakness 6
• Monitor wound healing and watch for infection or dehiscence 3
• Evaluate for complications such as nerve hypermobility or subluxation during the transition to mobilization 2