Cubital Tunnel Syndrome - Symptoms, Diagnosis & Treatment

A condition where the ulnar nerve (located in the arm) becomes irritated or compressed, causing a variety of pain and sensation related symptoms.

The ulnar nerve is a large nerve responsible for controlling most of the muscles in the hand, allowing its movement, and sensations in the little and ring finger. The ulnar nerve extends all the way down the arm, past the inside of the elbow and down into the hand, little and ring finger. The nerve passes behind a small bump of bone located in the elbow, this area is known as the medial epicondyle – this area of bone is often referred to as the 'funny bone'; when bumped, sensations of pins and needles are frequently reported – although these sensations are not caused by the bone itself, but rather by the ulnar nerve travelling beneath it, through a tunnel of tissue, known as the cubital tunnel. 

Cubital tunnel syndrome occurs when the cubital tunnel becomes narrowed in the medial epicondyle, resulting in compression or irritation of the ulnar nerve.

Causes

The cause is largely unknown; however it has been associated with other pre-existing conditions which can in some cases cause nerve compression or irritation such as:

  • arthritis/bone spurs on the elbow
  • swelling of the lining of the tendon
  • fractures
  • joint dislocation
  • fluid retention – this can occur during pregnancy
  • age related – this condition usually occurs in middle aged adults

Symptoms

Tingling sensations in the little and ring finger are commonly reported symptoms, along with pain, tingling and numbness in the hand – some patients may also experience a dull ache. In some cases, the compression may lead to clumsy movement in the hand with a weaker grip, causing the sufferer to drop things.

Painful symptoms often worsen when the elbow is bent or resting on a hard surface for extended periods of time, as bending the elbow further compresses the nerve.

Pain may be worse at night, or first thing in the morning due to a poor sleeping position such as a bent elbow or lying on the arm.

In more advanced cases, patients may experience constant numbness with a permanent loss of sensations in the little and ring finger, causing a 'dead like' feeling across the hand with a lack of strength and dexterity due to muscle wasting.

Diagnosis

A clinical examination will evaluate the physical symptoms and the patient's medical history; movement, sensation and strength of the muscles will also all be tested. Nerve conduction studies can help confirm the diagnosis of cubital tunnel syndrome, helping provide an accurate measurement of the amount of pressure on the nerves.

Treatment

Medication

Anti-inflammatory medication may help relieve painful symptoms. Other analgesics may also be used for pain relief.

Steroid Injections

Injections of anti-inflammatories and steroids into the cubital tunnel itself can provide effective relief; this treatment however, involves the risk of damaging the nerve.

Physiotherapy

A physiotherapist can advise on how to position your arm throughout the day and avoid certain movements, preventing further irritation. They may also devise a gentle exercise plan, known as ulnar nerve gliding.

Ulnar Nerve Splints

Bracing or splinting may be used to help maintain the arm in a straight position.

Surgery

In more severe cases, surgery may be the only option, although it comes with its own associated risks including, infection, adverse reaction to the anaesthetic and damage to the nerve.

Cubital Tunnel Release

Pressure on the ulnar nerve is released by dividing the ligament (roof) of the cubital tunnel – increasing the size of the tunnel itself and releasing pressure on the nerves.

Ulnar Nerve Anterior Transposition

This involves moving the nerve to the front of the medial epicondyle, preventing compression of the nerve during bending of the elbow.

Medial Epicondylectomy

Removing part of the medial epicondyle releases pressure on the nerve.

Pain Management

Pain is a complex illness – extremely debilitating in many cases, leaving many individuals as a result, struggling to cope with their symptoms on a daily basis. Pain Management physicians specialise in chronic pain related conditions and have a detailed knowledge and understanding of the physiology of pain and how to treat these often very complex conditions. The pain management clinic comprises of a multi-disciplinary team from different areas of health care, this may include surgeons, physiotherapists and psychologists. The pain management physician will not only treat painful symptoms, but also help patients cope with and manage their pain – ultimately improving their quality of life.

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