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Cubital Tunnel Syndrome

Anatomy of the Cubital Tunnel

The ulnar nerve travels down the back of the elbow behind a bony bump called the medial epicondyle and through a passageway called the cubital tunnel. The cubital tunnel is a narrow passageway on the inside of the elbow formed by bone, muscle, and ligaments. The roof of the cubital tunnel is covered with a tissue called fascia. 

What is Cubital Tunnel Syndrome?

When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump. When the ulnar nerve is compressed or entrapped, the nerve can become injured or inflamed, leading to cubital tunnel syndrome.

What are the Signs and Symptoms of Cubital Tunnel Syndrome?

In general, the signs and symptoms of cubital tunnel syndrome arise gradually. Left untreated, cubital tunnel syndrome can lead to permanent nerve damage in the hand. The commonly reported symptoms associated with cubital tunnel syndrome include:

  • Intermittent numbness, tingling, and pain to the little finger, ring finger and inside of the hand. These symptoms may occur more frequently at night and with the elbow bent.
  • Aching pain to the inside of the elbow
  • Weakness in hand with diminished grip strength
  • Diminished sensation and fine motor control in the hand causing you to drop objects or have difficulty in handling small objects
  • Muscle wasting in the hand

Diagnosis of Cubital Tunnel Syndrome

Your physician will review your medical history and perform a thorough physical examination of your elbow.

Your physician may order X-ray and electrodiagnostic tests such as electromyography and nerve conduction studies. These tests can assist your doctor in determining how well the nerve is functioning and locate areas of nerve compression.

Treatment Options for Cubital Tunnel Syndrome

Your physician will initially recommend conservative treatment options to treat the symptoms unless muscle wasting or more advanced nerve damage is present.

Conservative Treatment Options for Cubital Tunnel Syndrome

Conservative treatment options may include:

  • Avoiding frequent bending of the elbow.
  • Avoiding pressure to the elbow by not leaning on it.
  • Wearing a brace or splint at night while sleeping to keep the elbow in a straight position.
  • Avoiding activities that tend to bring on the symptoms.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) may be ordered to reduce swelling.
  • Referral to occupational therapy for strengthening and stretching exercises may be recommended.

Surgery for Cubital Tunnel Syndrome

If conservative treatment options fail to resolve the condition or if muscle wasting or severe nerve compression is present, your surgeon may recommend a surgical procedure to treat your condition.

The goal of cubital tunnel surgery is to reduce the pressure on the ulnar nerve by providing more space for the nerve to move freely and to increase blood flow for the ulnar nerve to heal. There are different surgeries that can be performed to treat your condition, such as:

  • Cuibtal tunnel release: Involves releasing all the compressive tissue overlying the nerve throughout its course around the elbow
  • Cubital tunnel release and ulnar nerve transposition:Involves releasing the compressive tissue around the nerve and creating a new tunnel in front of the medial epicondyle and transposing (moving) the ulnar nerve to the new tunnel

Your surgeon will decide which option is best for you depending on your specific circumstances.

Risks and Complications of Cubital Tunnel Surgery

Complications are infrequent but can occur following elbow surgery and may include:

  • Infection
  • Nerve damage causing permanent numbness around the elbow or forearm
  • Elbow instability
  • Elbow flexion contracture
  • Pain at the site of the scar
  • Persistent symptoms even after the surgery

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