Cubital tunnel syndrome R14

Cubital Tunnel is a condition that refers to the ulnar nerve being compressed around the elbow. It is the second most common compression condition of nerves in the upper limb. Carpal Tunnel Syndrome is the most common affecting the median nerve at the level of the wrist.

The ulnar nerve is commonly referred to as the “power house” of the hand, suggesting that it’s main function has to do with grip strength and fine motor co-ordination of the hand. The nerve runs behind the medial condyle of the elbow (funny bone) in a fibro-osseous tunnel and this zone is considered to be the area of compression. Symptoms are usually worse in flexion (bending) of the elbow as the nerve is stretched and compressed in this position.

Left Elbow Cubital
Diagram of the ulnar nerve supplying the muscles of forearm and hand.

Symphtoms

Pins and needles, with or without loss of sharp sensation might be felt in the little finger side of the hand involving half of the ring finger as well. In advanced cases the hand might get weaker and patients are prone to dropping things. Over months the muscles of the hand might become atrophied (wasted) and this is usually first visible between the thumb and index finger.

Diagram of the sensory distribution of the ulnar nerve in the hand.

The hand becomes weaker and patients are prone to dropping things.

Treatment

The problem is mechanical in nature and no medication or injection can reverse the problem. In the early phases, an elbow extension splint could be considered for night time. This splint keeps the elbow extended during sleep and prevents flexion of the elbow which is the natural fetal position people assume when they are asleep. This position tends to aggravate symptoms

If sensory symptoms do not resolve after 6-12 weeks of conservative management, or the hand gets weaker, then surgical management is considered.

The course of the ulnar nerve

No medication or injection can reverse the problem.

Surgical Procedure

Dissection and identification of the ulnar nerve

Potential Complications

The ulnar nerve released from the cubital tunnel.

Local anaesthetic may paralyse the nerve for a few hours after the operation.

Expectations after the Operation

Muscles have to be “re-innervated” and relearnt before they can work as they have worked before.

Rehabilitation after the Operation