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Cubital Tunnel Syndrome

What is Cubital Tunnel Syndrome (Ulnar Nerve Entrapment at the Elbow)?

Cubital tunnel syndrome occurs when the ulnar nerve, one of three nerves in your arm, becomes compressed in a tunnel of tissue (cubital tunnel) at the inside part of the elbow. The ulnar nerve travels from your neck into your hand. It provides sensation to some of the fingers of the hand and controls most of the muscles in the hand that assist with fine movements. The nerve also controls the larger forearm muscles responsible for gripping.

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What Causes Cubital Tunnel Syndrome?

While the cause of cubital tunnel syndrome is commonly unknown, several factors can compress the ulnar nerve at the elbow and increase your risk of developing cubital tunnel syndrome, including the following:

  • Prolonged or repetitive activities that require the elbow to be bent
  • Swelling or fluid buildup in the elbow joint
  • Cysts near the elbow joint
  • Bone spurs
  • Elbow arthritis
  • Previous elbow fracture
  • Previous elbow dislocation

What are the Symptoms of Cubital Tunnel Syndrome?

While cubital tunnel syndrome can result in aching pain at the inside portion of the elbow, most of its symptoms affect the hand, including the following:

  • Finger numbness and tingling – You experience numbness and tingling in the pinky and ring fingers, which may happen periodically. This sensation occurs most often when the elbow is bent.
  • Weakened grip and finger movement – You may experience a weakened grip and difficulty manipulating the fingers. Typically, these symptoms occur in severe cases of ulnar nerve compression.
  • Muscle wasting – In the most severe cases, muscle wasting (the loss of muscle mass) can occur. This happens if the nerve is severely compressed or compressed for prolonged periods. Muscle wasting cannot be reversed, a reason to see your doctor if your symptoms are severe or persist for more than 6 weeks.

How is Cubital Tunnel Syndrome Treated?

Your doctor will perform a physical examination of your hand and arm. This examination focuses on determining which nerve is compressed and where it is compressed. Your doctor may perform one or more of the following tests:

  • Your doctor may perform the Tinel’s Test by tapping lightly along the inside of the elbow, directly over the ulnar nerve. If the ulnar nerve is irritated, it will send a tingling sensation into the pinky and ring fingers (Tinel’s sign). This may occur when the nerve is in normal condition.
  • Your doctor may check your strength and feeling in your hands and fingers.
  • Your doctor may check whether your ulnar nerve moves out of normal position when you bend your elbow. This naturally occurs in some people and may irritate the nerve over time.
  • Your doctor may ask you to reposition your neck, shoulder, elbow, and wrist to see if it causes symptoms.

In addition to physical examination, your doctor may order specific tests. An X-ray can reveal the presence of bone spurs or arthritis that increase the risk of cubital tunnel syndrome. However, X-ray does not show most causes of ulnar nerve compression. Your doctor may also order nerve conduction studies, which determine how well a nerve functions and the location of compression.

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How is Cubital Tunnel Syndrome Treated?

Depending on the severity of your condition, your doctor may recommend non-surgical or surgical treatment options.

Non-surgical Treatments

  • Nonsteroidal anti-inflammatory medication – Your doctor may recommend anti-inflammatory medication to reduce swelling in the elbow.
  • Splinting or bracing – Your doctor may prescribe a splint or brace to prevent the elbow from bending. This splint or brace is worn at night.
  • Nerve exercises – Your doctor may recommend “nerve gliding exercises,” which are designed to help the ulnar nerve pass through the cubital tunnel at the elbow and Guyon’s canal at the wrist.

Surgical Treatment

Your doctor may recommend surgery if non-surgical methods do not improve your symptoms, you experience muscle wasting, or the ulnar nerve is severely compressed. Surgery aims to relieve the pressure on the ulnar nerve. Procedures include the following:

  • Cubital tunnel release – Your surgeon surgically increases the size of the cubital tunnel by cutting and dividing it. After surgery, the ligament begins to heal as new tissue forms at the presence of the division. The ligament heals with more space for the ulnar nerve to travel.
  • Ulnar nerve anterior transposition – To prevent the ulnar nerve from catching and stretching across the bony ridge of the medial epicondyle (bony bump of the elbow commonly referred to as the “funny bone”), the nerve is transposed from its position behind the medial epicondyle to a new position in front of it. The nerve can be repositioned under the muscle (submuscular transposition), within it (intermuscular transposition), or on top of it (subcutaneous transposition).
  • Medial epicondylectomy – This procedure removes part of the medial epicondyle to release the nerve and prevent it from getting caught on the bony ridge of the elbow when the elbow is bent.

Recovery

Depending on the procedure performed, you may need to wear a splint for several weeks after surgery. Your doctor may also recommend physical therapy to restore arm strength and movement.

Call Us To Schedule Your Appointment

If you recognize the signs and symptoms of cubital tunnel syndrome, contact us today to schedule a consultation with one of our highly trained physicians, who specialize in the treatment of upper extremity conditions.

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