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Cubital Tunnel Syndrome

What is cubital tunnel syndrome?

Cubital tunnel syndrome is a condition that causes pain and numbness in the little finger side of the hand. It is caused by compression of the ulnar nerve, which runs through the cubital tunnel, a narrow passageway on the inside of the elbow. Compression may be caused by bony osteophytes (bony lumps) or a fluid filled cyst.

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Who is affected by cubital tunnel syndrome?

Cubital tunnel syndrome can affect people of all ages, but it is most common in adults between the ages of 40 and 60. It is also more common in people who:

  • Have had a previous injury to the elbow, such as a fracture or dislocation

  • Participate in activities that put a lot of stress on the elbow joint, such as tennis or weightlifting

  • Have certain medical conditions, such as rheumatoid arthritis or diabetes

What are the main symptoms of cubital tunnel syndrome?

 

The main symptoms of cubital tunnel syndrome are:

  • Pain in the hand and fingers, especially the ring finger and little finger
  • Numbness and tingling in the hand and fingers, especially the ring finger and little finger
  • Weakness in the hand and fingers
  • Difficulty gripping objects
  • Claw hand, resulting in abnormal bending of the little and ring finger

The symptoms of cubital tunnel syndrome may be worse at night or when the elbow is bent.

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How is cubital tunnel syndrome diagnosed?

Cubital tunnel syndrome is usually diagnosed based on a physical exam and the patient's medical history. The doctor will ask about the patient's symptoms and any previous injuries to the elbow. The doctor will also examine the elbow for pain, tenderness, and range of motion limitations. Imaging tests, such as X-rays, ultrasound or MRI scans, may be required to rule out other causes of elbow pain. Nerve conduction studies can be useful to investigate a possible nerve problem and also determine where the potential nerve irritation is occurring. Ultrasound may demonstrate thickening of the ulnar nerve as it runs along the inside of the elbow, with increased sensitivity and reproduction of symptoms as the probe runs along the nerve. It may also help to identify any structures causing compression of the nerve.

One common test for cubital tunnel syndrome is the Tinel's sign test. To perform this test, the doctor taps on the ulnar nerve at the elbow. If the patient feels a tingling sensation in the hand and fingers, the Tinel's sign test is positive for cubital tunnel syndrome.

Another common test for cubital tunnel syndrome is the elbow flexion test. To perform this test, the patient bends their elbow at a 90-degree angle and holds it in that position for 30 seconds. If the patient feels pain or numbness in the hand and fingers, the elbow flexion test is positive.

How is cubital tunnel syndrome treated?

 

Treatment for cubital tunnel syndrome depends on the severity of the condition. Non-surgical treatments are often effective for mild to moderate cases of cubital tunnel syndrome. Non-surgical treatments may include:

  • Rest:

    Avoiding activities that aggravate the symptoms
  • Splinting:

    A splint can help to keep the elbow straight and reduce pressure on the ulnar nerve.
  • Physiotherapy:

    Physiotherapy can help to improve range of motion and strengthen the muscles around the elbow. It can also help to reduce sensitivity associated with ulnar nerve irritation
  • Medication:

    Over-the-counter pain relievers, such as ibuprofen or paracetamol can help to relieve pain and inflammation. Prescription pain relievers may be necessary for people with severe pain.
  • Corticosteroid injections:

    Corticosteroid injections can be used to reduce inflammation and pain in the cubital tunnel.

Corticosteroid injections can be a highly effective way of reducing inflammation and pain as a result of ulnar nerve irritation with cubital tunnel syndrome. At The Joint Injection Clinic, corticosteroid injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you in a seated position with the elbow resting on the couch.  The elbow is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  The ulnar nerve injection is performed with a small dose of steroid, targeting the area surrounding the nerve (perineural tissue), being careful to avoid injecting into the nerve itself. 

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

If non-surgical treatments are not effective, surgery may be an option. The goal of surgery is to relieve pressure on the ulnar nerve. Surgery may involve:

  • Cubital tunnel release:

    This surgery involves cutting the ligament that forms the roof of the cubital tunnel and widening the tunnel.
  • Ulnar nerve transposition:

    This surgery involves moving the ulnar nerve from the front of the elbow to the back of the elbow.

Additional tips for managing cubital tunnel syndrome pain:

  • Avoid activities that aggravate the symptoms, such as bending the elbow for long periods of time or leaning on the elbow.
  • Apply ice to the elbow to reduce pain and inflammation.
  • Use a brace or splint to keep the elbow straight and reduce pressure on the ulnar nerve.
  • Exercise regularly to strengthen the muscles around the elbow joint and improve range of motion.

If you are experiencing pain and numbness in the hand and fingers, it is important to see a doctor to get a diagnosis and discuss treatment options. With early diagnosis and treatment, most people with cubital tunnel syndrome can manage their symptoms and maintain a good quality of life.