Cubital Tunnel Syndrome
What is Cubital tunnel Syndrome?
Cubital tunnel syndrome, or the compression of the ulnar nerve at the level of the elbow joint, is the second most common disease in a group of conditions called compression neuropathies. The cubital tunnel is located inside the elbow joint, the ulnar nerve passes through it down to the forearm.
Why does an elbow nerve compression occur?
The cubital canal is one of the narrowest spaces along the path of the nerve. Both ligaments and muscles of the forearm surround the nerve in this tight space, if/when the muscles or tendons expand (due to hypertrophy, for example) the nerve can become trapped and compressed. People who work for extended periods of time with a bent elbow or strain their elbow joint on a regular basis are more likely to develop ulnar nerve entrapment and associated symptoms. Likewise, the disease can occur if the elbow joint is frequently traumatized – the resulting scar tissue can take up space and can press on the nerve. Cubital tunnel syndrome is often found in people of such professions as – drivers, office workers, professions involving having the elbow bent for extended periods of time.
What are the key features of cubital tunnel syndrome?
- Progressive tingling and pain in the little finger (pinky) and ring finger
- tingling and pain are more prominent during the day than at night
- In severe cases, a decrease of grasping strength can be observed
Note: If the condition is left untreated for extended periods of time, muscle wasting of the base of the palm can occur which in turn can limit range of motion of the fingers. Numbness and loss of sensation should not be ignored or overlooked, as that could potentially lead to irreversible nerve damage, loss of function of the arm and disability.
How is cubital tunnel syndrome diagnosed?
Diagnosis of cubital tunnel syndrome is based on the following:
- characteristic complaints;
- your doctor may detect the following during your examination – sensory disturbances in the area of the nerve, wasting of the corresponding and adjacent muscles, discomfort upon touching the cubital canal area (?);
- neurography (electromyography) – measures nerve impulse conduction speed as well as provides a qualitative analysis of these impulses ;
- ultrasonography. Provides additional information on changes in the tissues adjacent to the nerve – tendons, joints, and bones.
How is cubital tunnel syndrome treated?
Cubital tunnel syndrome is treated by a neurosurgeon. Since the main culprit of the disease is the impingement of the nerve, logically the main task of treatment is to reduce / prevent further nerve compression. There are several treatment options available depending on the level and extent of nerve damage.
In mild cases, treatment is started with medications, local injections (blockades), use of night orthoses and, where possible, improvement of work ergonomics. Additionally, physiotherapeutic exercises may be used. They help to reduce swelling and relieve the compressed nerve.
If previous treatment has no effect or the disease is initially very severe, surgery should be considered. A traditional surgical technique or the more recent and much less traumatic endoscopic technique is used to release the nerve. The operation is performed in an outpatient facility using combined general and local anaesthesia. The patient can go home shortly after the operation on the same day.
The greatest benefit of the endoscopic procedure is the small surgical wound which aids fast wound closure and healing, which is especially important in patients with underlying diseases that delay wound healing, such as vascular disease and diabetes.