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Cubital Tunnel Syndrome
Dr. Chee Kin Ghee
What is Cubital Tunnel Syndrome?
Cubital tunnel syndrome is a condition characterised by pressure or stretching of the ulnar nerve, also known as the “funny bone” nerve, which runs in a groove on the inner side of the elbow. This nerve controls sensations in the ring and little fingers and coordinates some hand movements. When compressed or stretched, it can lead to numbness, tingling, and pain in the elbow, forearm, and hand.
Cubital tunnel syndrome can result from various factors including elbow injury, prolonged bending of the elbow, and certain anatomical variations. It is recognised as one of the most common nerve compression disorders of the upper extremity, and it can impact daily activities and quality of life.
Symptoms
Cubital tunnel syndrome presents a range of symptoms that may vary in intensity from person to person.
- Numbness and Tingling
Patients often experience these sensations in the ring and little fingers, especially when the elbow is bent. - Pain in the Elbow
A common symptom, often exacerbated when the elbow is kept in a bent position for prolonged periods. - Weakness in the Hands
This may manifest as a reduced ability to grip objects or perform tasks requiring manual dexterity. - Muscle Wasting in the Inner Side of the Hand
In severe or long-standing cases, there can be noticeable thinning of the muscles on the inner side of the hand. - Fingers Bending Towards the Palm
In advanced cases, the ring and little fingers may bend permanently towards the palm.
Causes and Risk Factors
Cubital tunnel syndrome arises from factors that exert pressure on or stretch the ulnar nerve.
- Trauma to the Elbow
Injury to the elbow can lead to swelling, inflammation, or direct damage to the ulnar nerve. - Prolonged Elbow Flexion
Activities that involve keeping the elbow bent for extended periods, such as holding a phone or sleeping with the elbow bent, can increase pressure on the nerve. - Anatomical Variations
Some individuals have natural variations in their elbow structure that make them more prone to this syndrome. - Repeated Elbow Movements
Jobs or hobbies that involve repetitive elbow movements can contribute to the condition. - Medical Conditions
Conditions like arthritis or elbow tumours can alter the space within the cubital tunnel, affecting the nerve.
Diagnosis
Diagnosing cubital tunnel syndrome involves a combination of clinical evaluation and diagnostic tests.
- Medical History and Physical Examination
The first step involves discussing symptoms and medical history. A physical examination focuses on the elbow, assessing for numbness in the ring and little fingers, muscle weakness, and signs of nerve irritation. - Nerve Conduction Studies
This test measures how well and how fast the nerves can send electrical signals. It helps in confirming the diagnosis and determining the severity of nerve compression. - Electromyography (EMG)
An EMG assesses the health of muscles and the nerves controlling them. It can detect if the muscle is functioning properly in response to nerve stimulation. - Ultrasound or MRI
These imaging techniques may be employed to visualise the nerve within the cubital tunnel and to identify any anatomical abnormalities or conditions contributing to nerve compression.
Non-Surgical Treatment Options
Various non-surgical interventions are available to manage cubital tunnel syndrome, focusing on symptom relief and nerve protection.
- Elbow Splints or Braces
These devices may be recommended by your cubital tunnel syndrome specialist to keep the elbow in an extended position, especially during sleep, to minimise nerve compression. The consistent use of splints or braces can reduce the strain on the ulnar nerve. - Nerve Gliding Exercises
These exercises, designed by cubital tunnel syndrome specialists, aim to enhance the mobility of the ulnar nerve within the cubital tunnel. Regular practice of these exercises can help alleviate symptoms and improve nerve function. - Anti-inflammatory Medications
Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed to reduce swelling around the nerve, providing relief from pain and discomfort. - Steroid Injections
Injecting corticosteroids near the cubital tunnel can effectively reduce inflammation and swelling, offering temporary relief from symptoms. This treatment is usually considered when symptoms are persistent and impact daily activities.
Surgical Treatment Options
In cases where non-surgical treatments are insufficient or when cubital tunnel syndrome is severe, surgical interventions may be considered.
Cubital Tunnel Release
This procedure involves cutting the ligament over the cubital tunnel to increase its size and decrease pressure on the ulnar nerve. It allows the nerve more room to pass without being compressed.
Ulnar Nerve Anterior Transposition
This procedure helps move the ulnar nerve from its place behind the elbow to a new position in front of it. It can prevent the nerve from getting compressed when the elbow is bent.
Medial Epicondylectomy
This procedure involves removing part of the medial epicondyle, the bony bump on the inside of the elbow, to decrease tension on the ulnar nerve.
Prevention Strategies
Preventing cubital tunnel syndrome involves measures to reduce strain and pressure on the ulnar nerve.
- Avoid Prolonged Bending of the Elbow: Avoid keeping the elbow bent for extended periods. Adjust workstations, seating positions, and habits to maintain a neutral elbow position.
- Protect Elbow Against Injury and Strain: For those engaged in activities that put pressure on the elbow, protective elbow pads can be beneficial.
- Stretch and Strengthen the Elbow: Regular exercises that focus on the muscles of the arm and forearm can help maintain nerve health.
- Reduce Strain on the Elbow: Modify work environments to reduce repetitive strain on the elbow. This may involve ergonomic keyboards, chairs, and tools that support a natural arm position.
- Sufficient Rest Periods for the Elbow: Taking frequent breaks during activities that involve prolonged elbow flexion or repetitive motions can reduce nerve strain.
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Frequently Asked Questions (FAQ)
What Are The Stages of Cubital Tunnel Syndrome?
Cubital tunnel syndrome can be classified into three stages: mild, moderate, and severe. Treatment varies depending on the stage.
Should I Keep My Arm Straight With Cubital Tunnel Syndrome?
Yes, it is generally recommended to keep your elbow straight when you have cubital tunnel syndrome. This helps in allowing the ulnar nerve to recover and reduces inflammation. A nighttime elbow splint may be utilised to maintain this position while sleeping.
What is The Difference Between Carpal Tunnel Syndrome And Cubital Tunnel Syndrome?
While both syndromes affect the arms and hands, they have different sources and require different treatment plans. Carpal Tunnel Syndrome typically causes pain or numbness in the wrist, affecting the median nerve, while Cubital Tunnel Syndrome affects the ulnar nerve, often causing numbness in the pinky and ring fingers.
What Happens When Cubital Tunnel Syndrome is Left Untreated?
Leaving Cubital Tunnel Syndrome untreated can lead to serious complications, including muscle wasting, permanent nerve damage and weakness and coordination difficulty of the hands. Early treatment can prevent this. Consult our cubital tunnel specialist today to avoid complications.
Can Cubital Tunnel Syndrome be cured?
Yes, with appropriate treatment, which may include non-surgical methods or surgery, symptoms can be alleviated and nerve function can be improved. Reach out to our cubital tunnel syndrome specialist for a personalised treatment plan.