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
Left Elbow Cubital
Diagram of the ulnar nerve supplying the muscles of forearm and hand.
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
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.
- The patient is usually given a general
anaesthetic with a tourniquet around the
arm to create a bloodless field to ensure
optimal surgical vision.
- The nerve is identified in the upper arm and
carefully followed into the cubital tunnel.
The cubital tunnel is released and the nerve
is carefully freed from any adhesions.
- The nerve is followed into the fibrous arch
(which can compress it) between the two
heads of the flexor carpi ulnaris muscle. The
arch is released and the nerve is released
into the muscle belly of the flexor carpi ulnaris.
- The elbow is fully flexed and if the nerve is
unstable (jumping over the medial
epicondyle of the humerus) it is transposed
to the front of the medial epicondyle (funny
- The skin is closed in layers and a local
anaesthetic is injected in the skin.
- A loose bandage is applied that will prevent
the elbow from flexing.
Dissection and identification of the ulnar nerve
- The ulnar nerve is handled during surgery and
infrequently it might be paralysed for a period after
the surgery. The nerve is very sensitive to touch.
Furthermore the local anaesthetic might paralyse
the nerve for a few hours after the surgery creating
a numb feeling and weakness of the hand. This will
resolve within 12-16 hours.
- There is a small risk (<1.5%) for surgical wound
- There might be a numb feeling around the wound
for a few weeks after the operation. This is due to a
sensory nerve (the medial cutaneous branch of the
forearm) in the surgical field that needs to be
- Some people experience a sharp infrequent electric
pain that goes down the forearm after the operation
when they flex their elbow. This usually improves
after a few of days
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
- The sensory symptoms may improve a few weeks
post surgery, and fine touch may take up to 18-24
months to be restored, especially if the condition
had been present for a long time.
- The muscle power takes a longer time to be
restored. Essentially the muscles have to be
“re-innervated” and relearnt before they can work
as they worked before. Recovery is expected
between 18-24 months.
- Most patients get some relief of symptoms fairly
soon after the operation, especially the night
- The wound has to be kept dry for the first 10-14
days until the bandage and dressings come off.
Muscles have to be “re-innervated”
and relearnt before they can work
as they have worked before.
Rehabilitation after the Operation