I have a bad case of cubital tunnel syndrome. The doctor wants to operate. I have two choices. I can have the band of tight tissue across the nerve cut or I can have the nerve moved away from the tunnel it's in. How do I decide what to do?

Your surgeon is the best one to advise you on this. Often the decision isn't made until the surgeon is able to see what's going on inside. Pressure on the ulnar nerve along the outside of the elbow is the main cause of cubital tunnel syndrome (CTS).

This can be caused by a tunnel that's too small, scar tissue from past injury, or tight soft tissues outside the tunnel. There is a band of fibrous connective tissue called the cubital tunnel retinaculum that crosses the elbow. Its purpose is to keep the nerve inside the tunnel during elbow flexion and extension.

The retinaculum is cut during surgery to decompress the nerve. The surgeon may opt to make sure the nerve slides and glides inside the tunnel and leave it at that. It may be necessary to lift the nerve out of the tunnel and move it to another location. This operation is called an anterior transposition.

A recent study of CTS showed that the cause of the problem may be increased pressure inside the tunnel. If this is true, then a simple decompression may not be enough. It may be necessary to move the nerve out of and away from the narrow confines of the tunnel.

You can opt to do this operation in two stages. In the first operation, the retinaculum is cut. If you don't get relief from the symptoms, then the nerve transposition can be done at a later time.