Cubital Tunnel Syndrome

Cubital Tunnel Syndrome is a nerve compression affecting the arm and hand. You may have heard of it by the more common name, carpal tunnel syndrome. The two conditions are quite similar in how they are present but it is important to differentiate between them in order to treat them effectively.

Definition

In Cubital Tunnel Syndrome, over time, your ulnar nerve can be squashed, stretched or irritated  at the level of your elbow joint as it passes through the cubital tunnel causing it to become swollen and inflammed. 

The cubital tunnel is more commonly known as the funny bone, which sits just behind the bony bump (medial epicondyle) on the inside of your elbow. This tunnel comprises of muscle, bone and ligament.The ulna nerve’s function is both motor and sensory so it provides feeling and function to the forearm, wrist and hand. 

It provides sensation to the inside of your forearm and wrist and extends to the palmer surface of the hand through to the little finger, half of the ring finger, and to the tips front and back. It innervates the muscles involved in bending the wrist and fingers and adduction of the thumb.

If you can think of the last time you hit your funny bone, you might remember that you felt electric shocks or tingling in the ring and little fingers. This is because the ulnar nerve is responsible for this sensation. Irritation or  pressure on the ulnar nerve in the tunnel can prevent the nerve from sending its normal signals.

Causes

There are many reasons why the  ulnar nerve can be compressed or irritated at the cubital tunnel. 

• At the elbow level, repetitive elbow bending or sustained elbow flexion can irritate the ulnar nerve. As we bend our elbow, the ulnar nerve stretches and glides in order to travel beside the medial epicondyle. Therefore sustained or repetitive bending can cause irritation to the nerve. This more often happens at night because we often sleep with our elbows flexed. Other activities that are performed with the elbow flexed can also bring on the symptoms of cubital tunnel syndrome. These may include talking on the phone, reading a book or tablet or lying on your stomach propped up on your elbows.
• Leaning on the elbow can cause cubital tunnel syndrome as the nerve travels very close to the surface.
• Swelling in the elbow may compress the nerve as someone recovers from surgery or an injury. Occasionally, an increase in function such as gym work/gardening or work activities may also irritate the ulnar nerve.
• A decrease in the space/area of the tunnel itself which would in turn increase the pressure on the nerve such as space occupying lesions. Ganglions/lipomas, structural anatomical irregularities, degeneration of the elbow joint, or a healed elbow fracture with bone spurs can all contribute to the build up of pressure on the space/area.
• The ulna nerve for some people may sublux, move in and out from the medial epicondyle and irritate the nerve over time.

Other risk factors include diabetes, some types of arthritis and being overweight.Whatever the cause, the compression of the nerve means that it is no longer able to send its signals normally.

Signs & Symptoms

Patients usually present with a specific set of symptoms which is slightly different based on the length of time and how far the condition has progressed. It can loosely be classified as mild, moderate and severe in the degree of symptoms.

• Mild – pain as well as pins and needles that come and go
• Moderate – pain as well as pins and needles with measurable weakness
• Severe – constant pain as well as pins and needles with measurable weakness

The  above symptoms can extend all the way down the forearm into the ring and little fingers. There may be reported snapping or popping at the elbow level, with bending/straightening of the elbow. 

As the condition progresses then weakness may be observed – in grip strength, pinch strength, and of  the little finger. In more severe cases, the little finger may stick out to the side due to weakness. There may be atrophy (wasting) of the muscles in the hand and in the first webspace in the thumb. The little finger and ring finger may be resting in a claw position due to weakness.

Assessment

Cubital tunnel syndrome can be diagnosed by physical examination and performing manual 

tests in the clinic and completing questionnaires with your therapist. Your doctor may request  certain tests such as nerve conduction studies or electromyograms (EMG) to find out more about how the nerve is sending signals. 

treating cubital tunnel syndrome. They will be able to assess you and provide advice regarding the best treatment options. 

Our therapists have strong professional relationships with excellent surgeons who can be consulted if medical intervention is required.  The sooner cubital tunnel syndrome is diagnosed, the more effective treatments can be, so book an appointment to see  Melbourne Hand Therapist today!

Nerve conduction studies measure the time it takes for the electrical signal of the nerve to go from one point of the ulna nerve to another. Several points on the nerve are tested and an increase in time can identify where the nerve may be compressed.

An EMG  tests the muscles response and is often done in conjunction with nerve conduction studies. Electrodes are placed on the muscles corresponding to the ulna nerve which measures the electrical activity of the muscle as it contracts. With these studies they can also determine if there is associated muscle damage indicating the level of severity that the nerve is compromised.

Treatment

Depending on the severity and the time frame of progression of the condition treatment might vary. With a mild condition, therapy would be the first line of treatment. Many patients have complete relief from seeing a hand therapist for conservative treatments which may include:

• Rest and avoidance of aggravating activities or positions (i.e avoiding keeping the elbow flexed for prolonged periods) and avoiding resting the back of the elbow against surfaces.
• Elbow splints or braces at night may be recommended to hold the elbow in a more neutral position
• Nerve gliding exercises to improve nerve health
• Appropriate advice on posture and assessment of an ergonomic work setup

If the condition doesn’t improve or the severity increases to obvious muscle wasting, then surgical intervention may be indicated.

There are different types of surgeries for this condition. The Surgeon will decide which surgery will be appropriate based on the cause and severity. The surgery options include:

• Cubital tunnel release where the ligament roof of the cubital tunnel is divided which increases the size of the tunnel. 
• Ulnar nerve transposition. Usually the nerve is repositioned from its normal position, behind the medial epicondyle to a suitable position where it is no longer irritated. Moving it takes away the ability of the nerve to stretch around the medial epicondyle and therefore getting irritated.

• Medial epicondylectomy. This is where they remove part of the medial epicondyl, also preventing the nerve from getting caught/stretching around the medial epicondyle.

Prevention Of Cubital Tunnel Syndrome

• Keeping fit and healthy. Quitting smoking or avoiding smoking is really good for the health of your nerves.
• Modify activities that require maintaining prolonged postures, take regular movement breaks during your day.
• If you have a health condition in your medical history that is a risk factor for cubital tunnel syndrome, try to ensure the condition is well managed with your general practitioner. These risk factors include diabetes, some types of arthritis and being overweight.

Other risk factors include:

 Prior fracture or dislocation of the elbow

• Bone spurs
• Swelling of the elbow joint
• Cysts near the elbow
• Age – over 40 years
• Throwing activities, especially overhead
• Work or activities that involve prolonged or repetitive elbow flexion
• Resting on elbows

Melbourne Hand Therapy Can Help You

Like many conditions, cubital tunnel syndrome is more responsive to treatment if diagnosed and treated early. The hand therapists at Melbourne Hand Therapy are experts in diagnosing and

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