Cubital Tunnel Syndrome

Cubital tunnel syndrome occurs when the ulnar nerve is compressed in the cubital tunnel area of the elbow.

The ulnar nerve runs along the back of the elbow, passing behind the bony protrude known as the medial epicondyle, and travels through the cubital tunnel. This narrow passage is located inside the elbow and surrounded by muscle, bone, and ligaments, with the ulnar nerve running through the center. The cubital tunnel roof is made up of soft tissue referred to as fascia.

Bending the elbow causes the ulnar nerve to stretch or pinch against the bony bump. Compression or entrapment of the nerve can cause it to rip and become inflamed, resulting in the symptoms associated with cubital tunnel syndrome.

Symptoms

Cubital tunnel syndrome usually develops gradually, with symptoms worsening over time until medical attention is sought. If left untreated, it can result in irreversible nerve damage in the hand.

Common symptoms of cubital tunnel syndrome are:

• Intermittent tingling, numbness, and pain affecting the ring finger, little finger, and the inside of the hand, especially at night or when the elbow is bent or resting for extended periods.
• Aching discomfort on the inside of the elbow.
• Weakness in the hand that leads to reduced grip strength.
• Decreased feeling and fine motor control in the hand, making it difficult to hold small objects or causing objects to drop.

Muscle wasting in the hand and potential permanent nerve damage if not treated.

Causes

Common factors that contribute to cubital tunnel syndrome include:

• Trauma to the elbow.
• Previous fractures or dislocations of the elbow.
• Swelling of the elbow joint.
• Repeated elbow motion.
• Recurrent pressure on the elbow due to prolonged sitting postures, especially when leaning on the elbow.
• Activities like baseball pitching.
• Medical illnesses like ganglion cysts, bone spurs, or tumors in the cubital tunnel which can apply pressure to and irritate the ulnar nerve.

Diagnosis

Our physicians at The Joint Pain Clinic will first do a comprehensive medical history and physical examination to diagnose cubital tunnel syndrome.

In addition, they may suggest X-rays and electrodiagnostic tests like electromyography (EMG) and nerve conduction studies. They are mostly done to evaluate how well the ulnar nerve functions and to pinpoint parts of nerve compression or muscle wasting.

Treatment

Nonsurgical options

In the early stages of cubital tunnel syndrome, symptoms often improve if you stop the activities triggering them. Limiting tasks that involve frequent elbow bending and taking regular breaks can help. You may also talk with your supervisor to adjust your job duties.

Anti-inflammatory drugs can help manage symptoms. If symptoms worsen at night, wearing an athletic elbow pad or lightweight plastic arm splint while sleeping may help limit movement and reduce irritation. The splint should be worn to keep the elbow straight. The elbow pad can also be used in the daytime to protect the nerve against pressure caused by leaning.

Physical or occupational therapy is commonly recommended. Initially, your therapist will guide you on putting your elbow to rest and performing daily activities without further straining the joint. They may also use heat or other treatments to alleviate pain. Gradual stretching and strengthening exercises for the forearm muscles are typically part of the therapy.

Surgical options

If symptoms persist despite nonsurgical treatments and changes in activities, surgery may be necessary to prevent further damage to the ulnar nerve. This surgery aims to relieve pressure on the nerve as it goes through the cubital tunnel. Typically, the procedure involves releasing the pressure by cutting the tissue forming the roof of the cubital tunnel, known as ulnar nerve decompression.

If the ulnar nerve isn’t stable and moves excessively, decompression can be combined with a transposition procedure. This procedure involves creating a new tunnel using the forearm flexor muscles, and the ulnar nerve is transposed or moved from the cubital tunnel into the new tunnel.

Preventing Cubital Tunnel Syndrome

To prevent cubital tunnel syndrome, consider the following measures:

• Keeping arms flexible and strong.
• Avoiding resting on your elbows, particularly on hard surfaces.
• Warming up before participating in sports or engaging in repetitive arm movements.