Cubital Tunnel Syndrome
What is it?
Cubital tunnel syndrome is a condition caused by compression of the ulnar nerve, or “funny bone” nerve, at the level of the elbow.
What causes it?
The nerve normally takes a sharp bend over the outside of the elbow. Bending of the elbow, as well as pressure over the elbow area from resting the elbow, can cause increased pressure on the nerve. In addition, there are several anatomic structures, such as ligaments and muscles, around the inside of the elbow that can put pressure on the nerve. Sometimes, the nerve can become unstable in its normal groove as the elbow moves, jumping in and out of its socket. Increase pressure from these causes puts pressure on the nerve, which impairs its function and causes symptoms.
What are the symptoms?
Symptoms of dysfunction of the ulnar nerve involve numbness and tingling in the small finger and ring finger, as well as the palm and back of the hand leading up to those fingers. There can also be pain along the inside of the elbow. With advanced cases, there could be weakness of the muscles of the hand, and even wasting away of muscles in the hand. Symptoms may initially be intermittent in nature and are predominantly sensory in nature, occurring while bending the elbow with activities such as sleep or telephone use, or with pressure over the inside of the elbow such as when resting the elbow on the edge of a table. As the condition becomes more severe, the symptoms can involve the muscles of the hand, can become more intense, can occur with more frequency, and can become constant in nature.
How is it diagnosed?
A history and physical examination is usually sufficient to diagnose cubital tunnel syndrome. This can also help to evaluate for other conditions that cause similar symptoms, such as carpal tunnel syndrome, cervical radiculopathy (pinched nerve in the neck), neuropathy, thoracic outlet syndrome, and golfer’s elbow. Xrays can be helpful to evaluate for elbow abnormalities, such as arthritis, previous trauma, or malalignment, that could contribute to symptoms. Nerve studies can be obtained to confirm it, assess its severity, and to rule out other conditions.
How is it treated?
Conservative treatment of cubital tunnel syndrome is appropriate for those with mild or moderate symptoms. Activity modification, such as avoiding positions and activities that keep the elbow bent are important. Similarly, avoiding resting the elbow over edges of tables and armrests can also decrease symptoms. Overnight splinting of the elbow in extension can avoid the bent elbow position that causes symptoms overnight. When these measures fail to improve the condition, or when a patient presents with more severe symptoms, then surgery is typically recommended. Most of the time, a simple decompression, removing overlying tissues that put pressure on the nerve, is sufficient to resolve symptoms. Other times, the surgeon may determine that the nerve is better situated in the front of the elbow, in order to avoid the pressure or instability associated with bending the elbow. This can involve surgically placing the nerve either superficial or deep to the muscle about the elbow.
The recovery from the surgery is typically quick, although sometimes it may take weeks or months or longer for the nerve deficits to subside. Elbow motion and activity is allowed early, and therapy is not typically needed.
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