Cubital Tunnel Syndrome (Ulnar Nerve Entrapment)

What Is Cubital Tunnel Syndrome?

When the elbow bends, the ulnar nerve may stretch and rub against the bony prominence. If the nerve becomes compressed or trapped, it can become irritated and inflamed, which may lead to cubital tunnel syndrome.

What Are the Symptoms of Cubital Tunnel Syndrome?

In most cases, the symptoms of cubital tunnel syndrome develop more slowly and worsen over time, eventually prompting medical evaluation. If left untreated, the condition can result in permanent nerve damage in the hand.

Commonly reported symptoms of cubital tunnel syndrome include:

• Intermittent numbness, tingling, and pain in the little and ring fingers and inner hand, often worse at night or with elbow bending.
• Aching pain in the inside of the elbow.
• Weakness in the hand, often accompanied by reduced grip strength.
• Reduced sensation and fine motor control in the hand, causing objects to drop or have difficulty handling small objects.
• Loss of hand muscle mass and permanent nerve damage can occur if the condition is not treated.

What Are the Causes of Cubital Tunnel Syndrome?

Some of the common causes of cubital tunnel syndrome include:

• Trauma
• Repetitive motion
• Frequent pressure on the elbow for extended periods due to sitting posture
• Medical conditions such as bone spurs, ganglion cysts, or tumors in the cubital tunnel, leading to pressure and irritation of the ulnar nerve

Diagnosis of Cubital Tunnel Syndrome

Your physician will review your medical history and perform a detailed examination of your elbow. They may also order X-rays and electrodiagnostic tests, such as electromyography and nerve conduction studies, to evaluate nerve function and identify areas of nerve compression or muscle wasting.

Conservative Treatment Options for Cubital Tunnel Syndrome

Conservative treatment may include the following:

• Limit repetitive elbow bending, especially for long periods.
• Reduce pressure on the elbow by avoiding leaning on hard surfaces. Wearing elbow pads can help, particularly during desk work.
• Use a nighttime splint or brace to keep the elbow in a straight or slightly extended position while sleeping. Alternatively, loosely wrapping the arm with a towel and securing it can prevent excessive bending.
• Avoid activities that trigger symptoms, such as prolonged phone use or leaning your elbow on armrests.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help reduce pain and inflammation.
• Referral to occupational or hand therapy may be advised to improve strength, flexibility, and nerve mobility through guided exercises.

Surgery for Cubital Tunnel Syndrome

If non-surgical treatments do not improve your symptoms, or if there is muscle loss or severe nerve compression, your surgeon may recommend surgery.

The purpose of cubital tunnel surgery is to relieve pressure on the ulnar nerve. Surgery creates more space for the nerve to move freely and improves blood flow so the nerve can heal. Several surgical options are available, including:

• Medial epicondylectomy: This procedure removes the bony bump on the inside of the elbow, allowing the ulnar nerve to move smoothly when the elbow bends and straightens.
• Ulnar nerve transposition: This procedure moves the ulnar nerve to a new position in front of the bony bump, placing it in a new tunnel where it is less likely to be stretched or compressed.

Your surgeon will choose the best procedure based on your condition and individual needs.

Post-Operative Care for Cubital Tunnel Surgery

After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed. Common postoperative procedures include:

• A bulky dressing with a plaster splint is usually applied following surgery for 10 to 14 days.
• Elevating the arm above heart level and moving the fingers are important to prevent swelling.
• The arm dressing is removed after 10 to 14 days for the removal of sutures.
• Elbow immobilization for 3 weeks after surgery or longer is usually indicated, depending on the repair performed.
• Ice packs are applied to the surgical area to reduce swelling. Apply ice over a towel on the affected area for 20 minutes at a time, repeating every hour as needed. The surgical incision should be kept clean and dry. Cover the area with plastic wrap when bathing or showering.
• Occupational therapy will be ordered a few weeks after surgery for strengthening and stretching exercises to maximize the use of the hand and forearm.

Risks and Complications of Cubital Tunnel Surgery

Cubital tunnel surgery is generally safe, and most patients do not experience complications. However, as with any elbow surgery, certain risks may occur. These can include:

• Infection
• Nerve injury that may cause lasting numbness in the elbow or forearm
• Elbow instability
• Limited ability to fully bend or straighten the elbow
• Pain or tenderness at the surgical scar
• Persistent symptoms that do not fully improve after surgery

Your surgeon will discuss these potential risks with you before the procedure.