Cubital Tunnel Syndrome

Cubital tunnel syndrome refers to compression of the ulnar nerve at the elbow.

The ulnar nerve originates from the neck and travels down the arm to the hand. Along its course, the nerve passes just under the medial epicondyle of the elbow. The nerve distributes into the small and part of the ring finger.

Symptoms of cubital tunnel syndrome include tingling and numbness to the side of the hand and fingers. Some describe this sensation as their fingers falling asleep. This usually occurs when the elbow is bent. Some develop weakness and atrophy from this condition.

The cause of cubital tunnel syndrome is not entirely known. As described, the ulnar nerve does pass along the ridge of the elbow making is susceptible to compression.

Prolonged bending of the elbow can create a stretch upon the ulnar nerve causing symptoms to occur. This can occur with leaning on the elbow and also from sleeping with the elbow bent all night. Other risk factors for the development of cubital tunnel include previous trauma to the elbow, arthritic bone spurring and swelling around the joint.

The diagnosis of cubital tunnel syndrome is based on a patient’s medical history and physical examination. X-rays of the elbow may be ordered to rule out any bony abnormalities and to evaluate for significant arthritic changes. As the ulnar nerve arises from the neck, x-rays of the cervical spine may also be ordered as the symptoms of nerve compression in the neck are often similar to those of cubital tunnel syndrome. Electromyography (EMG) and Nerve Conduction Velocity (NCV) tests also can help aid in the diagnosis of ulnar nerve compression.

Treatment for cubital tunnel syndrome begins with simple modifications to try and relieve symptoms. This includes avoiding keeping the elbow bent for long periods of time and avoid leaning on the affected elbow. The use of a bath towel wrapped around the arm may be helpful at night to avoid sleeping with the elbow(s) bent.

Non-surgical treatments include the use of anti-inflammatory medication (NSAID), bracing, and stretching exercises.

For those who fail to improve with non-surgical care and for those who have evidence of significant nerve compression, surgery may be indicated. There are several different surgical techniques available that include anterior nerve transposition, cubital tunnel release, and epicondylectomy of the medial epicondyle. Each of these procedures has their advantages and disadvantages.

Recovery is often based on the chronicity and degree of nerve irritation.