Cubital Tunnel Syndrome: Cubital tunnel syndrome is a condition that affects the ulnar nerve where it passes the inside edge of the elbow. Cubital tunnel syndrome is the second common compression neuropathy in the upper extremity. Numbness and tingling sensation in the hand and fingers are common symptoms of cubital tunnel syndrome. Advanced disease is complicated by irreversible muscle atrophy and hand contractures.
Ulnar nerve decompression can help to alleviate symptoms and prevent more advanced stages of dysfunction.
Cubital Tunnel Syndrome Causes
There are a few causes of this ulnar nerve problem. One common cause of the Cubital Tunnel Syndrome is the frequent bending of the elbow, such as pulling levers, reaching, or lifting. There are various things that can cause stress on the nerve at the elbow-
The nerve has little padding over it. While bend your elbow, the ulnar nerve stretch around the boney ridge of the medial epicondyle, this stretching can irritate the nerve, keeping your elbow bent for long periods or frequently bending elbow can make painful symptoms. This can occur during sleep.
The nerve can be irritated from bending an elbow while you sit at a desk or from using the elbow rest during a long drive or while running machinery. The ulnar nerve can also be injured by a blow to the cubital tunnel.
Risk Factors for Cubital Tunnel Syndrome
- Prior fracture or dislocations of the elbow
- Cubitus valgus
- Subluxation of the ulnar nerve over the medial epicondyle
- Bone spurs/ arthritis of the elbow
- Swelling of the elbow joint
- Cysts near the elbow joint
- Medial epicondylitis (golfer’s elbow).
- Prolonged activities that require bent or flexed elbow repeatedly.
Cubital Tunnel Syndrome Symptoms
Cubital tunnel syndrome can induce an aching pain on the inside of the elbow. Maximum of the Cubital tunnel syndrome symptoms occur in your hand, can cause pain, loss of sensation, tingling, and weakness. “Pins and needles” are usually felt in the ring and small fingers. Symptoms are often felt while the elbow is bent for a long period, such as while holding a phone or while sleeping.
Some people with Cubital tunnel syndrome feel the weakening of the grip and difficulty with finger coordination, muscle wasting in the hand. These symptoms are usually seen in more severe cases of ulnar nerve compression.
Cubital Tunnel Syndrome Diagnosis
For diagnosis Cubital Tunnel Syndrome your physician will discuss your medical history and general health. S/he might test you for other medical problems like diabetes or thyroid disease.
Your physician will then do a physical exam- that may include-
- Tap over the nerve, if the nerve is aggravated, this can create a shock to the little finger and ring finger — although this can occur when the nerve is normal as well.
- Check for feeling and strength in the hand and fingers.
- Move your neck, shoulder, elbow, and wrist to see if various settings cause symptoms.
Most of the causes of ulnar nerve compression cannot be seen on an x-ray. However, your physician may take x-rays of elbow or wrist to scan for bone spurs, arthritis, that the bone may be compressing the nerve.
Sometimes, nerve testing (EMG/NCS) may be required to decide how well the nerve is working and help identify where it is being compressed. This test also checks for other problems such as a pinched nerve in the neck, which can cause similar symptoms.
Cubital Tunnel Syndrome Treatment
Non-Surgical treatment/Cubital Tunnel Syndrome Brace
Many cases of mild to moderate cubital tunnel syndrome can be managed without surgery. About 88% of these cases, cubital tunnel syndrome treatment without surgery. The first treatment is to avoid actions that cause symptoms. A physical therapist can help you find ways to avoid pressure on the nerve. Wrapping a pillow or towel loosely around the elbow or wearing a cubital tunnel syndrome brace at night to keep the elbow from bending can help.
Often times immobilization by the cubital tunnel syndrome brace of the elbow is required to treat cubital tunnel syndrome. Some points are remembered in the case of cubital tunnel syndrome-
• Avoid resting the elbow on hard surfaces. If you require resting your elbows, pad either your elbow or those hard surface.
• Avoid holding the elbow bent for lengthy periods of time. At night, splint the elbow in a straighter position by wrapping and tying a bath towel around the elbow or using a cubital tunnel syndrome brace made by a certified hand therapist.
Anti-inflammatory medications may help control the symptoms. However, limit the amount of time you do tasks that require a lot of bending in the elbow. Take frequent breaks and modify your job activities.
A physical therapist will show you how to rest the elbow and how to do your activities without putting extra strain on your elbow. Your physical therapist may apply heat or other treatments to ease the pain. Exercises are used to gradually stretch and strengthen the forearm muscles.
Cubital Tunnel Syndrome Surgery
Sometimes, Cubital Tunnel Syndrome surgery may be required to release the pressure on the nerve. This cubital tunnel surgery is also known as cubital tunnel release surgery. Many surgical treatments exist for the operation of cubital tunnel syndromes such as transposition of the ulnar nerve into the subcutaneous, or medial epicondylectomy, intramuscular, or submuscular plane have all been shown to be effective in the treatment of this disease process. Cubital tunnel surgery can be done applying a general anaesthetic, or a regional anaesthetic. Regional anaesthetic blocks have an axillary block, which would affect only the nerves of the arm. Cubital tunnel surgery is often done as an outpatient scheme. Therapy is needed after Cubital Tunnel Syndrome surgery, and the time it takes to recover can vary.
Your elbow will be placed in a splint and wrapped in heavy gauze, and elbow will be immobilized for three weeks. When the splint is eliminated, therapy will begin with passive movements. Your therapist gently moves your arm and gradually stretches your wrist and elbow. Active therapy starts six weeks after surgery. Light isometric strengthening exercises are started. At around eight weeks, you’ll begin taking more active strengthening. Your therapist will give you strengthening exercises in the wrist, elbow, and shoulder joints.