Cubital Tunnel Syndrome

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Cubital Tunnel Syndrome?

Cubital tunnel syndrome, also known as ulnar nerve entrapment, is a condition characterised by the compression or irritation of the ulnar nerve in the arm. This nerve, one of the three primary nerves in the arm, is particularly susceptible to compression in the area behind the inner part of the elbow. It plays a role in providing sensation to the little finger and half of the ring finger, as well as controlling the small muscles in the hand that facilitate fine movements.

The ulnar nerve’s vulnerability to compression or irritation at the elbow can result in a range of symptoms including numbness, tingling, weakness, and pain in the hand and fingers.

Causes of Cubital Tunnel Syndrome

Cubital tunnel syndrome arises from several factors that exert pressure on the ulnar nerve at the elbow.

  • Prolonged Elbow Leaning
    Prolonged elbow rest may contribute to nerve pressure. Occupations requiring frequent elbow leaning, such as plumbing or heating work, and activities involving sustained elbow pressure, like holding the plank position for extended durations, may elevate the risk of this condition.
  • Fluid Accumulation
    Fluid accumulation, such as oedema, may cause swelling in the elbow. This can subsequently compress the nerve.
  • Elbow Bending
    When the elbow is bent for long periods, the ulnar nerve stretches around the medial epicondyle, leading to irritation. Repetitive bending can cause the nerve to slide in and out from behind the medial epicondyle (nerve subluxation), irritating the nerve.
  • Elbow Trauma
    A direct blow to the inside of the elbow can injure the nerve. A blow to the tip of the elbow can also cause the bursa to produce excess fluid, leading to compression of the nerve.
  • Underlying Medical Conditions
    Certain predisposing factors may increase the risk of developing cubital tunnel syndrome. These include prior fractures or dislocations of the elbow, bony deformities, elbow arthritis, cysts near the elbow joint, repetitive or prolonged activities requiring elbow bending, and medical conditions such as diabetes or degenerative cervical spine issues​​.

Symptoms and Signs

Cubital tunnel syndrome manifests through a range of symptoms, primarily affecting the hand and elbow.


  • Localised Pain in the Elbow: This pain is often similar to the sensation experienced when hitting the “funny bone”.
  • Numbness and Tingling: Particularly in the ring and little fingers, often fluctuating in intensity.
  • Hand and Finger Weakness: Difficulty with grip and finger coordination, potentially leading to clumsiness.
  • Muscle Wasting: Observed in the inner forearm and hand in advanced cases due to prolonged nerve compression.

Diagnosis

Diagnosing cubital tunnel syndrome involves a comprehensive approach that includes medical history, physical examination, and various diagnostic tests:

  • Medical History and Physical Exam: An elbow specialist starts by assessing the patient’s medical history and conducting a physical examination. This helps identify signs of nerve compression and pinpoint the level of compression.
  • Nerve Conduction Study/Electromyography: These tests confirm nerve injury and identify affected muscles, providing insights into the severity and specific location of the nerve compression.
  • Imaging Tests: This can include X-rays and MRI scans. X-rays are used to examine the elbow for arthritis and bony deformities that might be contributing to the nerve compression. An MRI can help identify other potential causes of nerve compression, such as cysts or tumours.

Non-Surgical Treatment Options

Non-surgical treatments are often the first line of approach for cubital tunnel syndrome. These methods focus on alleviating symptoms and preventing further nerve damage.

Activity Modification

For less serious cases, the elbow specialist may initially suggest avoiding activities that aggravate the condition, such as repetitive elbow bending or resting the elbow on hard surfaces.

Brace or Splint

Using a brace or splint, especially at night, helps avoid excessive bending of the elbow, thereby reducing nerve compression.

Physical or Occupational Therapy

Therapy includes nerve gliding exercises designed to help the ulnar nerve slide more smoothly through the cubital tunnel. These exercises also aim to prevent stiffness in the arm and wrist, maintaining flexibility and function.

Anti-inflammatory Medications

These drugs, such as ibuprofen or naproxen, help reduce nerve inflammation and alleviate pain.

Surgical Treatment Options

In cases where non-surgical treatments for cubital tunnel syndrome are ineffective, or the nerve compression is severe, surgical intervention may be considered.

Cubital Tunnel Release

This surgery involves cutting and dividing the ligament that forms the roof of the cubital tunnel. This procedure enlarges the tunnel, thereby decreasing pressure on the ulnar nerve. New tissue growth is expected at the site of the ligament division, which aids in the healing process.

Ulnar Nerve Anterior Transposition

In this procedure, the elbow specialist relocates the ulnar nerve from behind the medial epicondyle to a position in front of it, closer to the skin. This relocation prevents the nerve from getting caught on the bone, reducing the likelihood of recurring compression.

Medial Epicondylectomy

This surgical option involves removing part of the medial epicondyle. The removal of this bony prominence relieves the nerve from entrapment, thus addressing the compression.

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Prevention Strategies

Preventing cubital tunnel syndrome involves several practical measures to reduce the risk of nerve compression and irritation.

  • Avoid Prolonged Stress on the Elbow - Avoid resting or leaning on the elbow for extended periods. This can reduce the risk of compressing the ulnar nerve.
  • Make Ergonomic Adjustments to Minimise Strain - Use ergonomic tools and equipment that minimise elbow strain. For example, adjust chair and desk heights to keep the elbow in a neutral position.
  • Rest the Elbow Regularly - Take regular breaks during activities that require prolonged elbow flexion, such as typing or using certain tools. This can help relax the elbow and prevent sustained pressure on the nerve.
  • Strengthening and Flexibility Exercises - Maintain good overall arm and hand strength through regular exercises. Keeping these areas strong and flexible can help protect the ulnar nerve from compression.
  • Using Protective Padding to Support the Elbow - Use protective padding or elbow pads to cushion the elbow, particularly when engaging in activities that might involve prolonged contact with hard surfaces.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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38 Irrawaddy Road, #08-62/63
Singapore 329563
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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    Can Cubital Tunnel Syndrome Affect Both Arms?

    Cubital tunnel syndrome can affect either one or both arms. The condition may develop in each arm due to various individual factors like repetitive strain or anatomical variations. Consult with an elbow specialist for tailored management strategies specific to each arm.

    What Happens If Cubital Tunnel Syndrome Goes Untreated?

    Untreated cubital tunnel syndrome can lead to complications such as muscle weakness, decreased hand function, and chronic pain. Early consultation with an elbow specialist can help prevent these complications.

    What Exercises Can Help Treat Cubital Tunnel Syndrome?

    Nerve gliding exercises, designed to help the ulnar nerve move more freely, are often beneficial in the treatment of cubital tunnel syndrome. These exercises, along with other therapy recommendations, can be provided by an elbow specialist to ensure effective and safe practice.

    Can I Return to Sports after Cubital Tunnel Syndrome?

    Returning to sports after cubital tunnel syndrome depends on the severity of the condition and response to treatment. An elbow specialist can help you make any necessary modifications to sporting practices to accommodate your condition.