What is Cubital Tunnel Syndrome?
Cubital Tunnel Syndrome is a compression syndrome involving a peripheral nerve, the ulnar nerve. It is also known as ulnar nerve entrapment and is the result of irritation or injury of the ulnar nerve in the cubital tunnel at the elbow, which is a narrow passageway for the nerve. This causes significant discomfort and disability in the forearm and hand.
Causes
Here are a few causes for ulnar nerve damage leading to Cubital Tunnel Syndrome:
- The direct pressure on the nerve: The ulnar nerve is vulnerable to compression at the elbow. Pressure by resting on the armrest of a chair, for example, can press on the nerve causing numbness on the lateral side of the hand.
- Stretching the nerve: Keeping the elbow at a bent angle for a long time can stretch the ulnar nerve. This often happens while sleeping.
- Snapping of the nerve. At times, the ulnar nerve snaps back and forth over a bump on the humerus as you bend your elbow. Repeating snapping can cause irritation of the nerve and damage.
- Space occupying lesions such as cysts or growths may cause compression of the ulnar nerve.
- Other rare causes for ulnar neuropathy include metabolic disorders, congenital deformities and arthritis.
- An occupational or athletic activity requiring repetitive overhead actions, or repeated flexion and extension of the elbow can also cause ulnar nerve damage.
Risk Factors for Cubital Tunnel Syndrome
- Head injuries leading to upper extremity contractures with the elbow in a flexed position.
- People over forty years of age
- Activities involving throwing objects overhead
- Occupations that require holding your hand with the elbow flexed for long periods of time, such as while holding a phone to your ear.
- Obesity
- Resting your elbows on hard surfaces for a long time.
Symptoms of Cubital Tunnel Syndrome
Patients with Cubital Tunnel Syndrome show the following symptoms:
- Numbness and tingling in the lateral part of the hand, along with the ring finger and the little finger, particularly when the elbow is bent.
- Numbness and tingling at night
- Pain in the hand
- Weak grip in the affected hand
- Aching pain on the inside of the elbow
How is Cubital Tunnel Syndrome diagnosed?
- Physical examination:
- Sensory changes in the form of numbness, tingling, or pins and needles sensation in the lateral part of the hand, along with the little and ring finger.
- Pain in the hand
- Atrophy of the intrinsic muscles of the hand that are supplied by the ulnar nerve. This is characterised by loss in volume and weakness.
- Elbow flexion tests and other tests to identify signs of instability of the elbow are done.
- Imaging studies:
- High-resolution neuro-ultrasonography can show changes in the size or position of the ulnar nerve along its course.
- X-rays can show evidence of degenerative changes of the cervical spine or elbow, as well as any bony spurs causing nerve compression symptoms.
- Magnetic resonance neurography is performed to assess the changes in the ulnar nerve.
- Electrophysiological studies. These studies help to assess the speed of conduction of the nerve signals. A speed of conduction below 50m/s is considered for Cubital Tunnel Syndrome.
Treatment of Cubital Tunnel Syndrome
Avoiding the action at the elbow joint that triggers Cubital Tunnel Syndrome is the most effective treatment. Your therapist may make recommendations such as:
- Avoiding bending the elbow joint
- Using an elbow pad to avoid keeping them on hard surfaces
- Using a splint or foam brace at night to limit movement and reduce irritation.
- Taking an anti-inflammatory medication such as ibuprofen
- Nerve gliding exercises: Exercises that help the ulnar nerve slide through the cubital tunnel at the elbow and through the wrist help to improve symptoms and reduce stiffness.
- If these methods prove ineffective, then you may be advised of other treatment options such as the injection of steroids to reduce pain and swelling.
- Surgery for Cubital Tunnel Syndrome: Surgery is the last resort in the treatment of Cubital Tunnel Syndrome. It is performed when there are progressive symptoms, sensorimotor deficits and a lack of improvement with conservative therapy. Surgical methods include simple decompression, medial epicondylectomy, and ulnar nerve transposition.
What can you do to prevent Cubital Tunnel Syndrome?
- Keep your arms flexible and strong by regularly exercising
- Don’t rest your elbows for long periods of time, especially on hard surfaces.
- Warm-up before you use your arms for overhead or other repeated activities during work or for sports.
Cubital Tunnel Syndrome exercises to relieve pain:
- Elbow flexion and wrist extension: Sit up on a chair and extend your hand at shoulder level with your hand facing the floor. Flex your hand and pull your fingers towards the ceiling. Bend your elbow and bring your hand to your shoulders. Repeat slowly five times.
- Head tilt: Sit up on a chair and stretch out your hand at the level of your shoulder. Turn your hand facing the ceiling and tilt your head in the opposite direction till you feel your muscles stretch. To increase the stretch, you can even extend your fingers toward the floor. Repeat slowly five times
- Arm flexion in front of the body: Sit up straight on a chair and reach out your arms in front of you with your hand outstretched facing away from you, and your fingers facing the floor. Bend your elbow and bring your wrist towards your face. Repeat slowly five to ten times.
- A-ok: Sit up straight and reach out your arm onto one side at the level of your shoulder. Turn your hand to face the ceiling. Touch your thumb to your pointer finger to make the ‘ok’ sign. Bend your elbow and bring your hand to your face covering your ear and jaw on the same side, with your fingers around your eye like a mask. Hold for three seconds before returning to the starting position, and repeat slowly five to ten times.
Dr. Abhishek M B | Senior Consultant – Orthopaedic | Sahyadri Narayana Multispecialty Hospital, Shimoga