Cubital tunnel syndrome

Georgios Panagopoulos MD | Orthopaedic Surgeon

What is cubital tunnel syndrome?

There are 3 main nerves in your arm: the median , the radial and the ulnar nerve. The ulnar nerve runs from your neck down to your arm and to your hand. The ulnar nerve is responsible for the control of some of the bigger muscles in the forearm, many of the muscles of the hand that help you perform fine movements (like playing an instrument) and provides sensation to the small finger and half of the ring finger. Cubital tunnel syndrome occurs when your ulnar nerve gets irritated or squeezed on the inside of your elbow. This is actually what is commonly referred to as the funny bone. That electric sensation you feel when you hit your funny bone is actually the compression of your ulnar nerve. The elbow is the most common site of entrapment of the ulnar nerve, as the nerve there has little padding and passes through a narrow canal (cubital tunnel). However, the ulnar nerve can occasionally be pinched elsewhere, such as the neck (cervical neuropathy) or at the wrist (at Guyon’s canal). An entrapped ulnar nerve can cause various uncomfortable and severe symptoms that, if left untreated, can lead to muscle weakness and atrophy.

Who is at risk for cubital tunnel syndrome?

Some of the factors that may put you at risk of developing cubital tunnel syndrome are the following:

• Elbow arthritis
• Prior fractures at the elbow, or bone spurs
• Subluxing ulnar nerve – some people have a snapping nerve

What’s the difference between cubital tunnel syndrome and carpal tunnel syndrome?

Carpal tunnel syndrome affects the thumb, index and middle fingers. It is caused by entrapment of the median nerve. Cubital tunnel syndrome affects the pinky and ring finger. It is caused by entrapment of the ulnar nerve.

What are the symptoms of cubital tunnel syndrome?

Symptoms of cubital tunnel syndrome may include:

• Pain on the inside of the elbow
• Numbness (falling asleep) & tingling (pins & needles) of the pinky and ring fingers
• Difficulty performing fine hand movements, like playing a musical instrument
• Dropping objects, hand feeling weak & clumsy
• Muscle atrophy, in severe chronic cases

How is cubital tunnel syndrome diagnosed?

Dr Panagopoulos can understand much about your condition by asking you about your symptoms and examining you. The Surgeon might test you for other medical problems, such as diabetes or thyroid disease. Sometimes, nerve testing (EMG/NCS) may be needed to see how much the nerve and muscle are being affected, as well as to check for other problems such as a pinched nerve in the neck, which may cause similar issues.

We recommend that you see your healthcare provider if you have any of the above symptoms for more than 6 weeks or if they are severe. You may get muscle wasting in your hand if you wait too long to get treatment for your entrapped nerve.

Cubital Tunnel Syndrome: conservative treatment

Initial treatment may be conservative and involve:

• Rest
• Activity modification
• Stretching exercises.
• Physiotherapy/home exercise program for strengthening and stretching exercises
• Wrist splinting, especially at night

Cubital Tunnel Syndrome: Surgical management

Treatments for cubital tunnel syndrome can be conservative/non-surgical (typically at first) or surgical (through a procedure at the elbow). The first course of treatment in cubital tunnel syndrome is activity modification in order to avoid the actions that cause it. Avoiding leaning on the “funny bone” can also help. Wearing a splint at night to keep the elbow from bending can help. A hand therapist can help you find ways to avoid exerting pressure on the ulnar nerve, as well as teach you nerve gliding exercises. Sometimes, surgery may be needed to relieve the pressure on the pinched nerve. This can involve releasing the nerve (cubital tunnel release), moving the nerve to the front of the elbow (anterior transposition), and/or removing a part of the bone (medial epicondylectomy). Either way, the procedure is typically performed under general anaesthetic and takes about 20-30 minutes. The patient goes home a few hours after the surgery, with a bulky dressing for a few days.

Dr Panagopoulos will discuss these options with you at the office during your visit. The time it takes to recover can vary. Pins & needles may improve quickly or slowly. Occasionally, it may take a few months for recovery after surgery. Cubital tunnel symptoms may not totally go away after surgery, especially if symptoms were severe at the first place. However, the procedure halts further nerve deterioration and functional impairment.

FAQs - Frequently Asked Questions