Cubital Tunnel Syndrome

OVERVIEW

Cubital tunnel syndrome occurs when the ulnar nerve, located in the arm, gets pinched or compressed behind the inside part of the elbow. This syndrome generally occurs from prolonged pressure on the nerve, usually caused by keeping the elbow bent for too long or from moving it too much and too vigorously for long periods. There are both nonsurgical and surgical options available to help get you back to your day-to-day activities. Surgical procedures are only recommended when nonsurgical treatments are ineffective. It is important to see a Florida Orthopaedic Institute physician as quickly as possible to prevent the condition from worsening to the point when the hand muscles begin to die and cannot be regained (muscle wasting).

ANATOMY

The ulnar nerve is one of the three major nerves in your arm. It travels from your hand up to your neck. It gives feeling to the little finger and half of the ring finger while also controlling most of the small hand muscles, as well as some bigger muscles in the forearm. It travels through a tunnel of tissue called the cubital tunnel, which runs under a bump of bone at the inside of the elbow, known as the medial epicondyle. This area of the elbow is commonly known as the funny bone, which causes a shock-like feeling when bumped because the nerve is so close to the skin.

Description

Several locations throughout the arm can compress the ulnar nerve, such as the collarbone or wrist. But the most common place for the ulnar nerve to be compressed is behind the inside part of the elbow. When this occurs, it results in a condition known as cubital tunnel syndrome.

Several factors that can cause pressure on the nerve at the elbow have the potential to lead to cubital tunnel syndrome. These factors include:

• When you bend your elbow, the ulnar nerve stretches around the boney ridge of the medial epicondyle (the bump of bone within the elbow). Since this stretching movement can irritate the nerve, repeatedly bending the elbow or keeping your elbow bent for long periods can aggravate symptoms of ulnar nerve compression.
• Leaning on your elbow for long periods can put pressure on the nerve, irritating it.
• In some people, the ulnar nerve will slide out from the medial epicondyle when the elbow bends. Over time, this sliding can irritate the nerve.
• Fluid buildup in the elbow can cause swelling that compresses the nerve.

Additionally, some risk factors put you at a higher risk of developing cubital tunnel syndrome, including:

• Repetitive or prolonged activities that require the elbow to be bent or flexed.
• Swelling of the elbow joint.
• Cysts near the elbow joint.
• Prior fracture or dislocations of the elbow.
• Bone spurs/ arthritis of the elbow.

Symptoms

There are several symptoms associated with cubital tunnel syndrome, including:

• Numbness and tingling in the ring and little fingers.
• The feeling of falling asleep in the ring and little finger, mostly when the elbow is bent.
• A weakening of the grip.
• A decrease in finger coordination.
• If the nerve has been compressed for an extended period, then muscle wasting in the hand can occur. Muscle wasting is when the muscle starts to die and cannot come back.

Diagnosis

Your Florida Orthopaedic Institute Physician will take a look at your symptoms and examine your arm and hand to determine which nerve is compressed and where that nerve is compressed. Your physician may also:

• Check if the ulnar nerve slides out of normal position when the elbow is bent.
• Check if the nerve is irritated by tapping over the nerve at the funny bone. If irritated, a shock is felt in the little and ring fingers.
• Check movement in neck, shoulder, elbow, and wrist to see if different positions instigate symptoms.

Your physician may also recommend some tests, such as x-rays. X-rays give detailed pictures of dense structures such as bone. While this test will not show the ulnar nerve, they will help to determine that your symptoms are not caused by a different condition.

TREATMENT OVERVIEW

There are many surgical and nonsurgical treatment options available. Nonsurgical options are recommended first as long as the ulnar neuritis has caused very little to no muscle wasting. If the muscle wasting is severe or if nonsurgical treatments have not helped, surgery may be necessary.

NONSURGICAL TREATMENTS

There are several nonsurgical treatment options available for cubital tunnel syndrome. Your physician may recommend some or all of the following:

• Non-steroidal anti-inflammatory medicines. Medications, like Advil & Motrin (ibuprofen) and Aleve (naproxen) may be recommended, which can help reduce swelling around the nerve.
• Nerve gliding exercises. Exercises to help the ulnar nerve slide through the cubital tunnel at the elbow can improve symptoms. These exercises can also help prevent stiffness in the arm and wrist.
• Bracing or splinting. Your physician may prescribe a padded brace or splint to wear at night to keep your elbow in a straight position, decreasing pressure.

SURGICAL TREATMENTS

Your Florida Orthopaedic Institute physician may recommend a surgical treatment to take the pressure off the nerve if nonsurgical methods have not improved your condition, the ulnar nerve is very compressed, or if nerve compression has caused muscle weakness or damage. The surgical treatments currently available include:

• Cubital tunnel release. During this procedure, the ligament “roof” of the cubital tunnel is cut and divided, increasing the size of the tunnel while decreasing pressure on the nerve. As the ligament heals, new tissue grows across the division, expanding the tunnel. This procedure works best when the nerve does not slide out from behind the bony ridge of the medial epicondyle when the elbow is bent.
• Ulnar nerve anterior transportation. This procedure, unlike cubital tunnel release, corrects the nerve’s location if it has slid out from behind the bony ridge of the medial epicondyle. During this procedure, the nerve is moved to lie either under the skin but on top of the muscle (subcutaneous transposition), under the muscle (sub-muscular transportation), or within the muscle (intermuscular transportation).
• Medial epicondylectomy. In this procedure, part of the medial epicondyle is removed, releasing the nerve. This technique will prevent the nerve from getting caught on the boney ridge of the medial epicondyle and stretching when your elbow is bent.

NEXT STEPS

Contact your Florida Orthopaedic Institute physician today for more information on cubital tunnel syndrome.