Concierge hand & upper limb · London
Cubital tunnel syndrome treatment, by a hand and upper-limb surgeon.
A proper assessment, nerve conduction studies, and the decompression or transposition technique that fits your grade — chosen with you, not sold to you.
Why patients choose us
- 01
A hand and upper-limb surgeon, in theatre
Not a general clinic and not a training list. A named consultant hand and upper-limb surgeon, a proper theatre, and the anaesthetic that suits you.
- 02
Conservative options on the table first
For mild grades a night splint, elbow padding and activity change often settle it. We say so before you commit to surgery.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private cubital tunnel treatment costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
Open in-situ decompression in our network: £2,200–£3,800, home the same day.
| Procedure | Indicative range | Typical duration | Discharge |
|---|---|---|---|
| Consultation with hand & upper-limb surgeon | £220–£400 | 30–45 min | Same visit |
| Nerve conduction studies (upper limb) | £350–£650 | 45 min | Same visit |
| In-situ decompression (open) under LA | £2,200–£3,800 | 30–45 min | Same visit |
| Endoscopic cubital tunnel release | £3,000–£4,800 | 30–60 min | Same visit |
| Medial epicondylectomy | £3,200–£5,000 | 45–60 min | Same visit |
| Subcutaneous ulnar nerve transposition | £3,500–£5,500 | 60–90 min | Same visit |
| Submuscular ulnar nerve transposition | £4,500–£7,000 | 75–120 min | Same visit |
Prices vary by clinic, by which surgeon does the case, by the anaesthetic chosen, and by whether hand therapy is bundled. We come back with a firm quote within one working day.
The problem
The right grading, the right technique, the right timing.
Cubital tunnel is often treated too late, or with the wrong operation. Nerve conduction studies and an honest McGowan grade should come before any decision on surgery.
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Symptoms but no diagnosis?
Numbness in the ring and little fingers has several causes — the wrist, the elbow and the neck. We work out which.
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Told to “live with it”?
For grade II and grade III disease, waiting risks permanent muscle wasting. We say when it is time to operate.
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Not sure which operation?
In-situ decompression, epicondylectomy or transposition — the technique is chosen on your anatomy, not a preference list.
The journey
From enquiry to rehab — what happens, in order.
Assessment, nerve conduction studies, decision, surgery (or conservative care), and rehab — one clinician from first message to review.
Phase 1 · Before treatment
Assessment and studies
Phase 2 · On the day
A few hours at the clinic
Phase 3 · After
Rehab and review
- 01
Before
You tell us what is going on
A short, confidential form. Numbness in the ring and little fingers, when it wakes you, whether the hand feels weak or clumsy.
- 02
Before
Clinical assessment
A named hand and upper-limb surgeon examines the elbow — Tinel’s at the cubital tunnel, elbow flexion test, Froment and Wartenberg signs, and intrinsic muscle bulk.
- 03
Before
Nerve conduction studies
Ulnar nerve conduction across the elbow confirms the diagnosis, grades severity, and rules out a proximal cause.
- 04
Before
A decision, together
McGowan grade, symptoms and lifestyle guide the plan — splinting and activity change, or a specific decompression technique.
- 05
On the day
The procedure itself
In-situ decompression, medial epicondylectomy or ulnar nerve transposition, in a proper theatre under LA with sedation or GA.
- 06
On the day
Home the same day
A short recovery, a light dressing, and home within a few hours. With sedation or GA you will need someone to collect you.
- 07
After
Rehab and review
Early gentle movement, hand therapy where needed, and a review at six weeks. Sensory recovery lags behind motor recovery.
Typical end-to-end: 2–3 weeks from enquiry to treatment. Motor recovery: weeks to months.
When it helps
When cubital tunnel treatment is the right step.
The situations we see most, plus the red flag that means surgery should not be delayed.
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Numbness in the ring and little fingers
Classic ulnar territory pins and needles — often worse at night or with the elbow bent.
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Weak or clumsy hand
Dropping things, a weak pinch, or trouble with fine tasks — a sign the motor fibres are affected.
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Prior elbow trauma or fracture
An old elbow fracture, dislocation or valgus deformity that has left the ulnar nerve chronically irritated.
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Cyclist or elbow-leaner
Prolonged elbow flexion on the handlebars, or leaning on the elbow at a desk, is a common driver.
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Positive Tinel’s and elbow flexion test
Tapping over the cubital tunnel triggers tingling, and holding the elbow fully bent reproduces symptoms within a minute.
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Ganglion or space-occupying lesion
A cyst or mass at the medial elbow can compress the nerve — imaging clarifies it before surgery.
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Failed conservative treatment
Persistent symptoms after six to twelve weeks of night splinting and activity change usually warrant surgery.
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Red flag: intrinsic muscle wasting
A visibly hollowed first web space or clawed ring and little fingers is McGowan grade III — surgery should not be delayed.
Treatment options
Surgery is not always the first step.
What each option on the table actually involves — and which fits which McGowan grade and anatomy.
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Night splinting in extension
A soft splint holds the elbow near-straight overnight, taking pressure off the nerve. First-line for mild grades.
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Activity modification and elbow padding
Stop leaning on the elbow, adjust the desk and handlebars, and pad the medial elbow. Simple, and often enough on its own.
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Gabapentinoids for pain
A short course of gabapentin or pregabalin can settle nerve pain while other measures take effect.
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In-situ decompression (open)
A small incision releases the cubital tunnel and Osborne’s ligament, leaving the nerve where it lies. The workhorse operation.
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Endoscopic cubital tunnel release
A shorter incision with an endoscope to release the same structures. Similar results, in the right hands.
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Medial epicondylectomy
Part of the medial epicondyle is removed so the nerve can shift forward without full transposition.
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Subcutaneous transposition
The ulnar nerve is moved in front of the medial epicondyle and sits just under the skin. Useful when the nerve subluxes.
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Submuscular transposition
The nerve is moved forward and placed under the flexor-pronator muscle. Reserved for revision or severe cases.
Our vetted London network
A small panel of hand surgeons, we picked them.
Consultant hand and upper-limb surgeons across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every surgeon in our network.
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Consultant hand and upper-limb surgeons, not trainees or generalists
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Nerve conduction studies arranged before any decision on surgery
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Conservative options genuinely offered for McGowan grade I disease
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A named surgeon who does your decompression or transposition themselves
Safety and recovery
What to expect afterwards — honestly.
Cubital tunnel surgery is generally safe and reliable, but the pattern of recovery is worth understanding — motor first, sensory later, and not every case is complete.
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Sensory recovery is slower than motor
Grip and pinch strength usually improve first. Numbness in the ring and little fingers can take months, and may not fully resolve in severe cases.
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Progressive intrinsic muscle wasting
Once the small hand muscles have wasted, they may not return. This is why grade III disease is not watched — it is operated on.
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Persistent numbness — ring and little
Some residual numbness is common after long-standing compression. Realistic expectations are set before surgery.
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Thumb-pinch weakness (Froment sign)
A positive Froment sign — the thumb flexing when pinching paper — reflects adductor pollicis weakness and needs monitoring.
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Elbow instability after transposition
Uncommon, but transposition can leave the medial elbow feeling tender or unstable for a few months. Hand therapy helps.
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Recurrent symptoms or re-operation
A small proportion need revision surgery, usually a transposition after a failed in-situ release. We flag this risk before you commit.
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Wound infection and ulnar neuroma
Wound infection is uncommon; a painful neuroma at the incision is rare but can need injection or revision.
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Complex regional pain syndrome
A rare complication of any hand or elbow surgery — early hand therapy and good pain control reduce the risk.
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Missed proximal compression
Symptoms can also come from Guyon’s canal at the wrist or from the cervical spine. Nerve conduction studies and examination rule these out.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and McGowan grade
Why the operation was done — symptoms, examination findings and McGowan grade I, II or III based on motor and sensory loss.
- 02 Technique
Anaesthetic and surgical technique
Whether it was done under LA, sedation or GA, and which technique was used — in-situ release, epicondylectomy, or transposition.
- 03 Findings
Nerve appearance and subluxation
How the ulnar nerve looked at surgery, whether it subluxes over the medial epicondyle, and any ganglion or scar tissue found.
- 04 Impression
Rehab plan and expected recovery
Read this first: the splint or sling plan, when to start therapy, and the realistic time course for sensory and motor recovery.
Recognised by major UK insurers
Cubital tunnel decompression is typically covered by major UK insurers when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about cubital tunnel syndrome treatment.
Quick answers on diagnosis, McGowan grades, technique choice, cost and recovery.
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What is cubital tunnel syndrome?
Compression of the ulnar nerve as it runs behind the medial elbow, in the cubital tunnel. It causes tingling and numbness in the ring and little fingers, and in more advanced cases weakness and wasting of the small hand muscles.
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How is it diagnosed?
On examination — a positive Tinel’s sign at the cubital tunnel, a positive elbow flexion test, Froment and Wartenberg signs, and assessment of intrinsic muscle bulk. Nerve conduction studies confirm slowing of the ulnar nerve across the elbow and grade the severity.
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What are the McGowan grades?
Grade I is sensory symptoms only, grade II adds measurable weakness, and grade III is weakness plus visible wasting of the intrinsic hand muscles. The grade guides how aggressively we treat.
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Do I need surgery, or can I try conservative treatment first?
For McGowan grade I, six to twelve weeks of night splinting, elbow padding and activity change is the sensible first step. Grade II and grade III usually need surgical decompression.
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Which operation is best — in-situ release, epicondylectomy or transposition?
In-situ decompression, open or endoscopic, is the first-line operation for most patients. Medial epicondylectomy or transposition is chosen when the nerve subluxes, in revision surgery, or when the surgeon judges the anatomy demands it.
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How much does private cubital tunnel surgery cost in London?
Roughly £2,200–£3,800 for open in-situ release, £3,000–£4,800 endoscopic, £3,500–£5,500 for subcutaneous transposition and £4,500–£7,000 for submuscular transposition. We confirm a firm figure within one working day.
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How long does recovery take?
Most people are back to desk work within one to two weeks after in-situ release and three to four weeks after transposition. Motor recovery begins over weeks; sensory recovery can take months, and depends on how long the nerve was compressed.
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Will I get full sensation back?
Often, but not always. Grade I and II tend to recover well. Grade III with established muscle wasting may leave residual numbness or weakness — early surgery gives the best chance.
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What can go wrong?
Wound infection, incomplete recovery, elbow tenderness after transposition, a painful neuroma, and rarely complex regional pain syndrome. Recurrent symptoms may need a revision operation.
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When should I seek urgent advice?
Rapidly progressing weakness, new visible muscle wasting, or numbness that has become constant are all reasons not to wait — book an assessment promptly rather than watching for weeks.
Related tests
Looking for something else?
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Nerve conduction studies
Confirms and grades ulnar nerve compression at the elbow.
Learn more -
Musculoskeletal MRI
Rules out a ganglion or space-occupying lesion at the elbow.
Learn more -
Cortisone shots
Occasionally considered for adjunctive symptom relief.
Learn more -
All tests and procedures
Every test and procedure we arrange.
Learn more -
Migraine
Related condition guide.
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Multiple Sclerosis
Related condition guide.
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Eeg
Related diagnostic test.
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In practice, in London
How cubital tunnel syndrome treatment tends to unfold when you go private
For cubital tunnel syndrome treatment, the private London route is mostly about consultant fit and hospital choice rather than raw waiting time. The wait for cubital tunnel syndrome treatment on the NHS depends heavily on where you live and how urgently the referral is graded. Central and West London private clinics can normally book within a week, with imaging or a procedure slot to follow shortly after. It’s worth being honest about the reason for going private: usually it’s time, not a fundamentally different test.
A private cubital tunnel syndrome treatment pathway in London usually looks like this: an initial consultation, any diagnostics booked at a nearby facility (most within Zone 1 or 2), and a written report sent to you and your GP within a few days. The consultants we work with hold NHS posts alongside their private lists, which keeps the standards consistent across both settings. For cubital tunnel syndrome treatment in particular, we bias towards consultants who do this every week rather than every month.
There are a lot of consultants in London who can technically handle cubital tunnel syndrome treatment. Fewer who do it week in, week out for the exact question you’re bringing. We spend most of our time working out which is which — and being straight when a different test or a different specialist would serve you better. Everything runs to CQC, GMC and Royal College standards; the choice is about fit, not floor.
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