Cubital Tunnel Syndrome

The elbow joint consists of the joining of three bones: one from the upper arm (humerus), and two from the forearm (ulna and radius). The collateral ligaments are strong bands of tissue that hold the bones together in proper alignment. The elbow is both a ball-and-socket joint as well as a hinge joint, allowing the elbow to bend (flexion) and straighten (extension) as well as enable the hand to rotate palm-up (supination) and palm-down (pronation).

Overview

The ulnar nerve travels through the cubital tunnel, which is a tunnel-like structure made up of tissues, that runs under the bump of bone, known as the medial epicondyle, located on the inside of the elbow. The spot where the nerve runs under the media epicondyle is commonly referred to as the “funny bone.” The reason why this is a sensitive area for most people, especially when bumped is because the nerve is very close to the skin, and bumping it causes a shock-like sensation. The ulnar nerve provides sensation to the little finger as well as part of the ring finger along with controlling most of the little muscles in the hand that help with detailed movement, and some of the bigger muscles in the forearm that enable a strong grip. Sometimes, the ulnar nerve gets compressed or irritated at the elbow causing pain or numbness in the elbow, hand, wrist, or fingers; this is called cubital tunnel syndrome.

Symptoms

Individuals who have developed cubital tunnel syndrome commonly have the following symptoms:

• Numbness or the sensation that the little and ring fingers are falling asleep especially when the elbow is in a bent position
• Overall numbness and tingling in the little and ring fingers that comes and goes
• Weakness in the grip and difficult with finger coordination

Early diagnosis and treatment of cubital tunnel syndrome can greatly help in reducing symptoms and avoiding muscle atrophy or “wasting”. Therefore, it is strongly advised to visit a physician if and individual experiences any of the aforementioned symptoms or suspects cubital tunnel syndrome.

Diagnosis

Diagnosis of cubital tunnel syndrome is generally made upon a physical examination and imaging studies. After taking a history of the symptoms and any prior injuries, the physician will examine the arm and hand to determine the location of the compression by tapping over the funny bone, observing the position of the ulnar nerve upon bending the elbow, checking to see if the movement of the neck or shoulder causes symptoms. The physician may order x-rays to rule out other conditions such as the formation of bone spurs due to arthritis. To confirm the diagnosis and identify the besta treatment option, the physician may also perform nerve conduction studies to determine the function of the nerve and the location of the compression.

Treatment

Early diagnosis of cubital tunnel syndrome will typically respond well to non-operative treatment, and for most people, the condition will only worsen if left untreated. The main objective of treatment is controlling inflammation and reducing symptoms. Operative treatment is typically a last resort after non-operative approaches have been exhausted or the compression has caused any muscle atrophy.

Medication – Pain relief medication such as acetaminophen as well as non-steroidal anti-inflammatory medicines (NSAIDs) can significantly reduce pain and swelling.

Brace or Splint – The physician might recommend the use of a supportive splint or an elbow pad with the fad facing forwards, worn over to limit excessive movement of the elbow and keep it in a neutral place.

Steroid Injections – Injecting the wrist with cortisone, a powerful anti-inflammatory medicine, might aide in decreasing pain, however, the pain is likely to return.

Nerve Gliding Exercises – The physician might recommend performing specific exercises that help the ulnar nerve glide through the cubital tunnel. These exercises may also help in keeping the arm and the wrist from getting stiff.

Surgery – Surgery may be an option when more-conservative treatments don’t relieve pain caused by severe cubital tunnel syndrome, especially if there are signs of any muscle atrophy or “wasting.” The goal of surgery will be to reduce or eliminate the pressure on the ulnar nerve at the elbow. Options must be discussed extensively with the physician to identify the appropriate surgical procedure.

Recovery

Recovery, especially after a surgery, will usually take several weeks if not months. Each patient is unique and their recover will depend on the treatment method prescribed by the physician and the severity of the initial problem. If surgery is deemed necessary for cubital tunnel syndrome, the tunnel may be widened to relieve pressure on the nerve (decompression) or the nerve may be moved to a different position with less pressure or tension (transposition). Full recovery from surgery can take several months since nerves recover at a slow rate, but once recovered, the individual may return to their prior level of activity.

Disclaimer

CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!

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