Cubital tunnel syndrome, also known as ulnar nerve entrapment, occurs when the ulnar nerve becomes compressed or irritated as it passes through the cubital tunnel. The cubital tunnel refers to the tunnel of tissue that runs under the bony bump at the inside of your elbow (medial epicondyle). In most cases symptoms can be controlled with conservative treatments such as modification of activity and bracing. If conservative treatments fail or the nerve compression causes weakness or damage in the hand, surgery may be recommended.
Symptoms
- Numbness and tingling in the hand, little and ring fingers. These symptoms may come and go but occur most commonly when the elbow is bent.
- Night symptoms
- Hand and finger pain
- In more severe cases:
- Hand grip weakness
- Difficulty with finger coordination
- If the nerve has been compressed for an extended period of time, muscle wasting or atrophy of the hand may occur. Once muscle wasting occurs, it can not be reversed, therefore it is important to see your doctor if your symptoms are severe or have been present for over six weeks.
Causes
- Compression or irritation of the nerve.
- “The ulnar nerve is especially vulnerable to compression at the elbow because it must travel through a narrow space with very little soft tissue to protect it.” (direct quote-can be reworded) https://orthoinfo.aaos.org/en/diseases--conditions/ulnar-nerve-entrapment-at-the-elbow-cubital-tunnel-syndrome/
- Repetitive bending of the elbow–reaching, lifting, or pulling levers-causing the ulnar nerve to stretch several millimeters.
- The ulnar nerve shifting or snapping over the medial epicondyle- the bony point on the inside of the elbow. Over time, this can irritate the nerve and could result in nerve damage.
- Fluid build up around the ulnar nerve
- Leaning on your elbow for an extended period of time
- Trauma to the cubital tunnel.
Prevention
- Avoid repetitive or prolonged bending of the elbow
Risk Factors
- Repetitive or prolonged activities that require bending of the elbow
- History of fracture or dislocations of the elbow
- Bone spurs or arthritis in the elbow
- Swelling of the elbow joint
- Cysts near the elbow joint
Diagnosis
Your doctor will review your medical history as well as your general health as it pertains to your daily activities and work requirements. A thorough physical examination of your arm and hand will be done to determine if and where your nerve is compressed.
- X-rays: X-rays may be conducted to detect bone spurs, arthritis or any other bony abnormalities that may be causing nerve compression.
- Nerve conduction studies: Nerve conduction studies are performed to determine how well the nerve is working, to help identify where the nerve is being compressed, and to determine if the compression is causing muscle damage.
Treatment
- Cubital tunnel syndrome can be treated by a variety non-surgical methods. If symptoms do not resolve despite conservative medical treatment and changes in your daily activities, your doctor may determine that surgery is the best treatment to stop further damage to the ulnar nerve.
Non-surgical
- Discontinue or modify repetitive and irritating activities. (example: When performing a task that demands frequent elbow bending, limit the amount of time you apply towards it. Take frequent breaks and modify the activity)
- Non-steroidal anti-inflammatory medicines (NSAIDs)- To help reduce swelling around the nerve.
- Elbow pad: An elbow pad may be worn during day while at work or while you sleep. If the symptoms are more severe at night, an athletic arm pad or a plastic arm splint may limit movement and ease irritation while you sleep. Always remember to wear the pad in the bend of the elbow to help keep the elbow straight.
- Occupational or physical therapy: A therapist with provide helpful tips on how to rest the elbow and how to perform necessary activities while reducing strain on the elbow joint. They may also teach you exercises and stretching techniques that can help strengthen the forearm muscles while also providing pain relief.
