What is Cubital Tunnel Syndrome?
Cubital tunnel syndrome happens when the ulnar nerve, which passes through the cubital tunnel (a tunnel of muscle, ligament, and bone) on the inside of the elbow becomes inflamed, swollen, and irritated.
The ulnar nerve travels right next to the bone at the elbow, and there is very little cushion between the bone and the nerve. This closeness puts extra pressure right on the nerve. The result is a pins-and-needles sensation, numbness or tingling. Depending on how the nerve is positioned, it might snap back and forth over the joint as the elbow is moved. When the nerve is repeatedly rubbed against the bone, inflammation develops.
The ulnar nerve can also be irritated from spending long periods holding the elbow in a bent position. Sometimes this can happen during the night while sleeping. This stretches the nerve too much, and causes painful symptoms. In some cases, the connective tissue that covers the nerve or variations in the muscle structure around the elbow can also place extra pressure on the nerve.
Cubital tunnel syndrome causes pain that feels a lot like when you hit your "funny bone" in your elbow. The "funny bone" is actually the ulnar nerve. The ulnar nerve begins in the side of your neck and ends in your fingers. Cubital Tunnel Syndrome can be very painful, and it can cause you to feel weak or clumsy.
The cause of cubital tunnel syndrome is unknown. However, existing health conditions like arthritis of the elbow or an injury or fracture can both contribute to the development and worsening of cubital tunnel syndrome. Repetitive motions that require constant bending of the elbow can also contribute.
Other potential causes of this condition are:
Pressure: The ulnar nerve has little padding over it, so direct pressure (like leaning your arm on an arm rest) can cause the arm and hand — especially the ring and small fingers — to “fall asleep.”
Stretching: Keeping the elbow bent for a long time can stretch the ulnar nerve. This can happen while you sleep or if you are holding a phone for a long period of time, for example.
Anatomy: Sometimes, the ulnar nerve simply does not stay in its place. It will snap back and forth over a bony bump as you move your elbow, which can irritate the nerve.
Cubital tunnel syndrome is diagnosed when symptoms are serious enough to interfere with the normal nerve function. These are most noticeable in the ring and small fingers, and pain may fluctuate around the elbow. Symptoms may worsen when the elbow is held bent for a long time, like while talking on the phone, driving or sleeping. When left untreated, muscle weakness can occur and sensation may be lost.
The initial treatments for cubital tunnel symptoms are conservative. Bracing the elbow to prevent it from bending, especially at night, can be helpful. Also, avoiding leaning on the elbow when it’s bent and avoiding tasks that require repetitive elbow movement can help reduce the symptoms. Ibuprofen can be taken to reduce swelling, or steroid injections can also help relieve discomfort. In some cases, hand therapy may be recommended to improve nerve movement to reduce irritation.
When these approaches haven’t helped or if the nerve is very compressed, surgery is the next step. There are two options for cubital tunnel treatment: cubital tunnel release and ulnar nerve transposition. In the release procedure, the ligament of the cubital tunnel is opened to decrease nerve pressure. More commonly, nerve transposition is the preferred surgical approach. During surgery, the nerve is moved further from the bone to prevent further irritation. Some surgeons may prefer a third option: removing a portion of the funny bone to prevent the nerve from rubbing against it.
Recovery following surgical cubital tunnel treatment occurs gradually. Initially, you will need to wear a splint. The length of time recovery takes varies depending on which surgical approach was taken. Physical therapy is often included as part of the healing process. Although it can take a long time for nerves to heal, many people experience significant relief of symptoms after recovery.
For more information or to request an appointment, please contact Dr. Patrick McDaid, M.D. at www.mcdaidorthohand.com/contact
