Cubital Tunnel Syndrome

Symptoms

Cubital tunnel syndrome can cause an aching pain on the inside of the elbow but most of the symptoms occur in your hand: 

• Numbness and tingling in the ring finger and little finger that comes and goes
• The feeling of “falling asleep” in the ring finger and little finger
• Weakening of the grip and difficulty coordinating the fingers
• Muscle wasting along the inner aspect of the forearm and hand may occur if the nerve has been compressed for a long time

Causes

The exact cause of cubital tunnel syndrome is not known but there are a number of factors that can cause pressure on the nerve at the elbow:

• Leaning on your elbow for a long period of time puts pressure on the nerve
• Fluid accumulation in the elbow causes swelling that may compress the nerve
• A direct blow to the inside of the elbow can injure the nerve
• The ulnar nerve is stretched around the bony ridge of the medial epicondyle when bending your elbow for prolonged periods, resulting in nerve irritation
• The nerve may slide out (sublux) from behind the medial epicondyle when the elbow is bent, and this repetitive sliding back and forth may irritate the nerve

Some conditions that predispose to cubital tunnel syndrome include:

• Prior fracture or dislocation of the elbow 
• Bony deformities of the elbow
• Elbow arthritis: resulting in recurrent elbow swelling and bone spurs that press on the nerve
• Cysts near the elbow joint
• Repetitive or prolonged activities that require the elbow to be bent 
• Certain medical conditions, such as diabetes or a degenerative cervical spine may make the nerve more susceptible to the effects of compression

Diagnosis

Your orthopaedic specialist will gather your medical history followed by a physical examination to check your arm and hand for signs of nerve compression and determine the level at which it is compressed. 

You may also be required to undergo the following tests:

• Nerve conduction study/Electromyography: to confirm the nerve injury and the muscles affected
• X-rays: to check for elbow arthritis and bony deformities of the elbow
• MRI: to check for causes of nerve compression e.g., cysts, tumours

Treatment

Non-surgical treatments are usually recommended as first line treatment. This includes taking anti-inflammatory medications to reduce the nerve inflammation and using a brace or splint to avoid prolonged/excessive elbow bending activities, especially at night. Physical or occupational therapy can be useful and involves doing nerve gliding exercises. 

If conservative treatments prove to be ineffective, your orthopaedic specialist may recommend surgery to relieve pressure on the ulnar nerve. This involves a decompression, to release the structures causing nerve compression, and transposition, where the nerve is relocated outside of the cubital tunnel to reduce the recurrence of compression. 

Every case is different; hence it is best to consult an orthopaedic specialist for an accurate diagnosis so that you can obtain the best treatment option that is most suitable for you. Reach out to us today if you suspect you are suffering from cubital tunnel syndrome and let us help you enjoy a better quality of life.