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Cubital Tunnel Syndrome

Man With Pain In Elbow. Pain relief concept

What is cubital tunnel syndrome?

Cubital tunnel syndrome is a common condition where one of the major nerves (the ulnar nerve or “funny bone”) of the upper extremity becomes compressed in a small tunnel at the elbow. Essentially, it is a pinched nerve at the elbow level. With limited space for the ulnar nerve within the compact cubital tunnel, the nerve can easily become compressed.

What causes cubital tunnel syndrome?

Although there have been many theories for why cubital tunnel syndrome occurs (related to work, repetitive activities, specific motions, etc), the reality is that the true cause is usually unknown. Generally speaking, it is an issue of space – when the nerve does not have enough space, it can become compressed, and this can in turn cause symptoms. Other ways that the nerve can come under pressure include: joint dislocations; fractures; arthritis; fluid build-up during pregnancy.

What are the symptoms of cubital tunnel syndrome?

The main symptom that indicates cubital tunnel syndrome is numbness or tingling of the last one and a half fingers of the hand (half of the ring and small finger). Tingling is often worse at night or first thing in the morning. It may be provoked by activities that involve flexing the elbow, or provoked by sleeping with the elbow flexed. Patients may be awoken in the middle of the night by “night pain,” and may feel the need to “shake out their hand” to improve symptoms. In early cubital tunnel syndrome, the symptoms of tingling will be temporary and intermittently return to normal. If the condition gets worse, the feeling may become continuous. Patients often described a feeling of clumsiness and drop objects easily. In severe cases, the muscles in the forearm and the internal muscles of the hand may irreversibly waste away.

How is cubital tunnel syndrome diagnosed?

The diagnosis of cubital tunnel syndrome is generally made on physical examination. Your doctor will perform numerous physical exam maneuvers, and combined with the story of your injury, will determine if cubital tunnel syndrome is suspected. Testing will be requested to help confirm the diagnosis – a nerve conduction study and electromyography. Additional testing such as an ultrasound or x-ray may also be required to help diagnose the injury.

What treatments are available for cubital tunnel syndrome?

The goal in treating cubital tunnel syndrome is to improve the feelings of numbness, tingling, and pain while also ensuring the disease process does not progress to cause irreversible damage to the ulnar nerve. At The Center for Hand & Upper Extremity Surgery, we use an algorithmic approach to treating this common problem

Depending on how severe your case is, your doctor may start with non-operative measures to improve your symptoms. This will include changing the patterns of how you use and position your hand as well as splinting to reduce pressure on the nerve.

If your symptoms continue, or if you have a severe case, we may pursue surgical treatment to decompress the nerve. We use a minimally invasive incision to prevent a large scar on your elbow, and also to improve your recovery. The procedure involves a small incision on your elbow, followed by releasing the ulnar nerve by finding and removing all of the common compression points.

If your condition includes atrophy or “wasting away” of muscles, then your condition is more advanced and more severe. In this situation, every attempt will be made to reverse the damage that has already been done. We use a special approach for patients with severe atrophy after nerve compression or nerve injury which involves not only addressing the compression or damage on the affected nerve, but also “supercharging” the damaged nerve with another nerve to give it extra electrical supply. This “supercharge” procedure requires meticulous microsurgical nerve technique and has the potential to accelerate the recovery as well as restore some of the lost function to your hand.

Will I need therapy after cubital tunnel syndrome surgery?

Most patients do not require formal hand therapy after cubital tunnel release. Motion is started immediately after surgery, and stiffness is uncommon. For patients who undergo simultaneous nerve transfer, there is a special therapy protocol required to activate the nerve transfers.


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