Cubital Tunnel Syndrome

What is Cubital Tunnel Syndrome?

For those affected by cubital tunnel syndrome, everyday activities such as sleeping with the elbow bent can result in numbness and pain in their ring and pinky fingers. If left untreated, cubital tunnel syndrome may lead to weakened grip strength and permanent nerve damage in the hand.

So what is this condition? Cubital tunnel syndrome is the compression of the ulnar nerve. This nerve starts in the neck, wraps around the inside of the elbow traveling through a tunnel known as the cubital tunnel, then travels into the forearm and the hand. The ulnar nerve provides feeling in the small finger and half of the ring finger. It also gives you grip and pinch strength, allows you to bend your small and ring fingers, and allows you to open and close your fingers. The ulnar nerve can be compressed in several places including your hand, but is most commonly compressed at the elbow due to the narrow space that it has to travel through at the elbow. The ulnar nerve becomes especially irritated when the elbow is flexed for too long or too frequently. Although elbow pain or soreness may occur with cubital tunnel syndrome, most symptoms of this condition occur in the hand. The most common symptoms of cubital tunnel syndrome are as follows:

● Numbness/tingling or a feeling of “falling asleep” in the small and ring fingers. This can come and go or become persistent in more severe cases. These symptoms typically occur more often when the elbow is bent.
● Hand weakness in severe cases. This includes weakened grip strength and weakened pinch strength.
● Muscle wasting – The back of the hand may start losing its contour and look thinner. Once the muscle is affected, it cannot be reversed or improved. It is very important to prevent further muscle damage by obtaining proper treatment.

Causes

There is no one true cause for developing cubital tunnel syndrome. However, some patients are at higher risk for developing compression of the ulnar nerve at the elbow.

Risk Factors

There is no one true cause for developing cubital tunnel syndrome. However, some patients are at higher risk for developing compression of the ulnar nerve at the elbow.

Prior Injuries/Anatomy: Patients who had previous elbow fractures or injuries, as well as an abnormal anatomy that places extra pressure on the ulnar nerve, are at greater risk. In some people, the nerve may slide in and out of place at the elbow and can eventually lead to cubital tunnel syndrome.
Elbow Positioning: Bending your elbow too frequently or for long periods can also place too much pressure on the nerve irritating it. This is especially common when people sleep, as we tend to sleep with our elbows bent. Additionally, resting on your elbows for long periods can also irritate the ulnar nerve.
Swelling/Cysts: Fluid buildup and swelling in the elbow can lead to ulnar nerve irritation as well. Sometimes cysts can grow along the cubital tunnel leading to nerve compression.

Hitting or bruising your ulnar nerve at the elbow, such as falling onto your elbow, can cause similar symptoms to cubital tunnel syndrome. However, these symptoms typically resolve on their own and do not commonly need surgical intervention.

Exams

During the exam your doctor may ask you what elbow or hand positions make your symptoms worse. They may also check which fingers become numb in your hand. The physician may lightly tap on your nerve at the elbow to see if you get any electrical shocks or numbness in the small and ring fingers. The physician will also test your hand strength and look for any muscle wasting in your hand. They will also check if your ulnar nerve moves out of position at the elbow. Additionally, the physician will check for any other spots of compression, such as your neck and wrist.

Tests

If your doctor suspects cubital tunnel syndrome, they may order an x-ray to evaluate your elbow anatomy to ensure no bony structures are compressing the nerve. They may also recommend an Electromyography (EMG) and Nerve Conduction Velocity (NCV) study to determine the severity of compression across the elbow, as well as to rule out other causes of nerve compression. The test is conducted by an EMG/NCV specialist such as a neurologist or physical medicine and rehabilitation physician. Here at Seaview, your EMG and NCV tests may be conducted by pain management specialist Dr. Adam Meyers. The tests measure electrical activity of muscles and the speed of electrical signals traveling along the nerve across specific sites in the arm, including elbow and wrist. During the EMG, a small needle is inserted into specific muscles to measure and record electrical impulses within selected muscle fibers.

What is Cubital Tunnel Syndrome like?

Cubital tunnel surgery involves releasing the tight ligaments surrounding the ulnar nerve at the elbow, which gets rid of the pressure on the nerve. This procedure improves blood flow allowing the nerve to heal. An incision is made on the inside of your elbow to visualize and protect the nerve while the tight structures are being released. If your nerve is unstable, or moves around the elbow instead of staying within its groove, your surgeon may have to move it to a more secure location to prevent symptoms from recurring. Depending on the type of surgery you
have, the physician may also place you in a splint for a few weeks after the procedure to protect and rest the elbow. You may experience soreness in your elbow for about 3 months after surgery.

Post Cubital Tunnel Syndrome Care & Recovery

The surgery is performed at a surgical center where you can go home the same day. Pain experienced after the procedure is typically managed by alternating Tylenol and anti-inflammatory medications. Very rarely will a stronger type of medication be necessary for managing pain after your procedure. A follow-up visit will be scheduled 10-14 days after surgery to have your sutures removed and the incision site checked by your physician. Physical or hand therapy is not necessary after cubital tunnel surgery. However, if your elbow becomes stiff and you are unable to straighten, bend, or rotate your elbow and forearm completely, the physician may recommend physical or occupational therapy to help improve your range of motion.

After your first follow up appointment, you may begin slowly easing into your normal daily activities according to your comfort levels. After 6-8 weeks, you may resume activities that require gripping, pulling and pinching. It can take up to 3 or more months to regain full strength depending on the severity of your cubital tunnel syndrome. Following your procedure, daily numbness and tingling can take several months to a year to improve depending on the extent of the nerve compression. Nerves tend to recover slowly, so you may notice improvement even a year removed from surgery. It should be noted that in severe cases daily numbness and tingling, as well as grip and pinch strength, may not completely recover.

Cubital Tunnel Syndrome Treatment in Central New Jersey and Jersey Shore 

At Seaview Orthopaedics, we offer a full range of treatment options for Cubital Tunnel Syndrome, including on-site physical therapy. Our hand, wrist, and elbow specialists, Dr. Joseph Gower, Dr. Monika Debkowska, Dr. Kevin McDaid, and Dr. Arthur Vasen are available for appointments at our six office locations. If you would like to Book Appointment, please call (732) 660-6200. We look forward to helping you!