Cubital Tunnel Syndrome
The cubital tunnel is a passageway through which the ulnar nerve passes at the elbow. Trauma to the ‘funny bone’ causing pain and tingling along the medial or ulnar side of the forearm and hand is where the ulnar nerve runs in the cubital tunnel.
In cubital tunnel syndrome, the compression of the nerve is more chronic, but leads to pins and needles or tingling in the little and ring fingers. If more severe it leads to weakness and wasting in the muscles of the hand (the ulnar nerve supplies most of the muscles in the hand), and patients may experience clumsiness in doing fine tasks, drop things or are unable to grip things properly.
Some patients classically wake with tingling and numbness in the little and ring finger) due to sleeping with bent elbows tensioning the nerve, or experience the same symptoms with prolonged mobile phone use. Irritation of the nerve is mostly due to compression in the cubital tunnel, but occasionally may be due to instability of the nerve, with it dislocating out of the tunnel when bending and straightening the arms.
Compression may be caused by a number of issues, from fibrous bands covering the tunnel, to osteophytes (bony prominences secondary to arthritis) to even tumours of the nerve. In rare cases, the compression of the nerve is at a place called Guyon’s canal in the wrist, but symptoms will be directed here.
- Management
The principle of management is to relieve pressure on the nerve.
Non-operative
Early stages of cubital tunnel may be managed non-operatively, with splints and education around preventing any tension on the nerve.
Operative
If there is progression of symptoms or there is evidence of muscle weakness then the nerve needs operative release. This may be done through an open cut or endoscopic technique, where the nerve is decompressed from its tunnel. In certain cases where the nerve is very irritated or is unstable, it may need to be repositioned anterior to the elbow in a procedure called a transposition.
A nerve ‘regenerates’ at 1mm per day and with approximately 300mm to get to the hand, postoperative recovery may take 3-12 months to resolve, particularly if the nerve has been compressed for some time and there is muscle wasting in the hand. Note that the recovery of muscle bulk is unpredictable, and it is recommended not to ignore the symptoms for too long.
Conditions Managed
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