What is Cubital Tunnel Syndrome?
Cubital tunnel syndrome results from entrapment of a nerve (ulnar nerve) on the inner-rear side of your elbow. Usually the nerve is pinched by a connective tissue band. The space through which the nerve runs is quite narrow and becomes even smaller when bending the elbow, which can trigger symptoms. Because the nerve is pinched, it can no longer transmit signals properly and symptoms develop.
In some cases, the ulnar nerve can actually move too much, causing it to shoot back and forth over a bone on the inside of the elbow when bending the elbow, which can cause a shooting pain when sliding with concomitant symptoms due to irritation of the nerve.
What are the symptoms in cubital tunnel syndrome?
The ulnar nerve provides sensation in the little finger and half of the ring finger. The little finger side of the back of the hand is also supplied with sensation by the nerve. In addition, the nerve runs to various hand muscles (intrinsic hand muscles) and to a flexor muscle of the wrist and to the deep flexors of the ring finger and little finger.
Irritation of the ulnar nerve at the elbow due to compression or entrapment can cause partial failure of the nerve. This often causes tingling and/or sensory disturbances in the area supplied by the ulnar nerve, such as the little finger and half of the ring finger, the little finger side of the hand and sometimes the forearm. Weakness may also occur to the muscles controlled by the nerve and you may see hand muscles become thinner. Bending the elbow or leaning on the elbow can trigger the symptoms.
Diagnosis
The pattern of symptoms will be questioned and a physical examination will be performed. If cubital tunnel syndrome is suspected, an additional EMG (electromyogram) will be performed to measure the nerve conduction of the ulnar nerve. The nerve can also be pinched at the level of the wrist; this gives a slightly different pattern of symptoms and requires different treatment.
Once the diagnosis of cubital tunnel syndrome is finalized, a treatment plan is developed depending on the severity of the symptoms and the patient's overall condition.
Treatment
Non-operative (conservative) treatment
If there are mild symptoms or if the symptoms are most likely transient then non-operative treatment may be suggested. The treatment aims to relieve the nerve and to avoid provocative movements and postures as much as possible. Not keeping the elbow bent for too long is recommended. Wearing a brace (splint) during the night that ensures the elbow is not flexed during sleep may reduce symptoms.
Surgical treatment
If the symptoms are severe or conservative treatment does not help enough, surgical treatment is chosen. The surgery is done in day surgery. The entire arm is numbed by a nerve block or general anesthesia is used. The structures trapping the nerve are passed through so that the nerve can regain sufficient space. If the nerve does not stay neatly in its tunnel, it is sometimes moved to the subcutaneous fat, or it is placed between the muscles.
The wound is sutured with stitches that can be removed after 10-14 days. After the procedure, you will have a pressure bandage for several days to weeks and will need to take it easy for some time.
Often complaints of tingling diminish fairly quickly after surgery. If the symptoms before surgery were severe in nature or if the nerve was severely pinched then recovery may take longer.
During the consultation hour, you will receive detailed information about post-treatment and recovery, as well as an information brochure about the procedure.
