Cubital tunnel syndrome
QT Pathologies (EN)
There is a bump of bone on the inner portion of the elbow (medial epicondyle) under which the ulnar nerve passes.
At this site, the ulnar nerve lies directly next to the bone and is susceptible to pressure.
When the pressure on the nerve becomes great enough to disturb the way the nerve works, then numbness, tingling, and pain may be felt in the elbow, forearm, hand, and/or fingers.
- The ulnar nerve (yellow) passes under the medial epicondyle on the inner portion of the elbow Anatomy images courtesy and copyright of Primal Pictures Ltd – www.primalpictures.com
Pressure on the ulnar nerve at the elbow can develop in several ways :
- Compressive force : arm leaned against a table on the inner part of the elbow, thicker connective tissue over the nerve, or muscle structure variations over the nerve at the elbow
- Traction or stretching : holding the elbow in a bent position for a long time, or following trauma
- Friction : an unstable ulnar nerve at the elbow clicks back and forth over the bony bump (medial epicondyle) with repetitive elbow flexion
Cubital tunnel syndrome symptoms usually include pain, numbness, and/or tingling. The numbness or tingling most often occurs in the ring and little fingers. The symptoms are usually felt when there is pressure on the nerve, such as sitting with the elbow on an arm rest, or with repetitive elbow bending and straightening.
Often symptoms will be felt when the elbow is held in a bent position for a period of time, such as when holding the phone, or while sleeping. Some patients may notice weakness while pinching, occasional clumsiness, and/or a tendency to drop things. In severe cases, sensation may be lost and the muscles in the hand may lose bulk and strength.
Your physician will assess the pattern and distribution of your symptoms, and examine for muscle weakness, irritability of the nerve to tapping and/or bending of the elbow, and changes in sensation.
A test called electromyography (EMG) and/or nerve conduction study (NCS) may be done to confirm the diagnosis of cubital tunnel syndrome and stage its severity. This test also checks for other possible nerve problems, such as a pinched nerve in the neck, which may cause similar symptoms.
X-rays of the elbow with cubital tunnel view is required to assess the bones and joint.
Symptoms may sometimes be relieved without surgery, particularly if the EMG/NCS testing shows that the pressure on the nerve is minimal.
Changing the patterns of elbow use may significantly reduce the pressure on the nerve. Avoiding putting your elbow on hard surfaces may help, or wearing an elbow pad over the ulnar nerve may help.
Keeping the elbow straight at night with a splint also may help. A session with a therapist to learn ways to avoid pressure on the nerve may be needed.
When symptoms are severe or do not improve, surgery may be needed to relieve the pressure on the nerve.
Several operations are used, including simple opening of the roof of the tunnel (decompression), moving the nerve into a new location at the front of the elbow (transposition) and widening the tunnel by removing some of its bony floor (medial epicondylectomy). Your surgeon can advise on the technique most appropriate to your problem.
Following surgery, the recovery will depend on the type of surgery that was performed.
Kinesitherapy may be necessary.
The numbness and tingling may improve quickly or slowly, and it may take several months for the strength in the hand and wrist to improve.
Cubital tunnel symptoms may not completely resolve after surgery, especially in severe cases.
During your consultation, Dr. D'Agostino will discuss the current treatment options and can help you choose the best treatment based on your particular case.