Key Points About Cubital Tunnel Syndrome
Cubital tunnel syndrome is a problem with the ulnar nerve, which passes through the inside of the elbow. It causes pain that feels a lot like the pain you feel when you hit the “funny bone” in your elbow.
Cubital tunnel syndrome may happen when a person frequently bends the elbows, leans on their elbow a lot, or has an injury to the area. Arthritis, bone spurs, and previous fractures or dislocations of the elbow can also cause it. In many cases, the cause is not known.
The most common symptom of cubital tunnel syndrome is numbness, tingling, and pain in the hand and/or ring and little finger, especially when the elbow is bent.
Cubital tunnel syndrome can be treated with rest and medicines to help with pain and inflammation. Exercises may help too. In some cases, surgery may be done.
Why Choose Cooper To Diagnose And Treat Cubital Tunnel Syndrome
Cooper University Health Care has a team of four fellowship-trained and board-certified or -eligible hand surgeons with extensive experience in diagnosing and treating cubital tunnel syndrome. You can count on us for:
- State-of-the-art diagnostic resources: Cooper offers a comprehensive array of sophisticated technology for diagnosing cubital tunnel syndrome, including:
- Musculoskeletal ultrasound : We are one of the few centers in the region to offer this advanced modality
- Nerve conduction studies: To determine how well the ulnar nerve is working and help identify where it is being compressed
Cubital Tunnel Syndrome Diagnosis
History, examination and special testing confirm the diagnosis of this condition. The history is exactly like that noted above.
Testing essentially consists of one or two tests. The stretch test involves holding the elbow in extreme flexion for about 30 seconds to a minute. This position stretches the ulnar nerve and typical symptoms can be reproduced.
The Tinels test has to do with the exquisite sensitivity of any nerve at an injury point. A nerve that is injured will fire an ectopic focus down to the end of nerve when stimulated. Percussion of the injury area will elicit this lightening bolt. In the case of cubital tunnel syndrome, the injury point is in this cubital tunnel where the nerve has been compressed. A positive test will produce an electrical zap into the ring and pinky fingers with percussion of the nerve at the elbow.
Some physicians will perform a two-point discrimination test. This test uses the ends of monofilament fishing line on a tool that can separate these two points at a specific distance. This tool is used to determine the smallest distance that a patient can identify the distance between these two points. In cubital tunnel syndrome, this distance will be larger than normal in the ring and small fingers as the sensitivity of the skin here diminishes.
Finally, an electrical test called an EMG/NCV can be used to determine if there is conduction loss or muscle weakness. A negative test would not preclude a diagnosis of cubital tunnel syndrome.
Recommended Reading: Slitting Wrists Success Rate
Physical Therapy And Manipulation
A graduated physical therapy program may be beneficial in restoring range of motion and overall conditioning of the neck musculature. In the first six weeks after onset of pain, gentle range-of-motion and stretching exercises supplemented by massage and modalities such as heat, ice, and electrical stimulation may be used, although this approach has no proven long-term benefit. As the pain improves, a gradual, isometric strengthening program may be initiated with progression to active range-of-motion and resistive exercises as tolerated.3
No high-quality evidence has proved the effectiveness of manipulative therapy in the treatment of cervical radiculopathy. However, limited evidence suggests that manipulation may provide short-term benefit in the treatment of neck pain, cervicogenic headaches,3,17 and radicular symptoms.18 Rare complications, such as worsening radiculopathy, myelopathy, and spinal cord injury, may occur.3,19 Because of these risks and the lack of high-quality evidence to support its effectiveness, manipulative therapy cannot be recommended for the treatment of cervical radiculopathy.
Theres Nothing Funny About Cubital Tunnel Syndrome
At some point in your life, youve probably hit that spot on your elbow commonly called the funny bone. Banging your elbow against a table, doorway, or other solid object is painful because there is very little tissue between the nerve and your elbow. It generates an electrical sensation that travels from the elbow down your arm.
The funny bone in your elbow is actually the ulnar nerve that runs from your neck to the tips of your fingers, and it hurts quite a bit when the nerve experiences trauma.
Cubital tunnel syndrome pain feels a lot like hitting your funny bone and can be caused by repetitive movements, such as pulling, lifting, or reaching with your arms, or from a traumatic injury to the area. Cubital tunnel syndrome may also be a result of bone spurs, arthritis, or a dislocation of the elbow.
Don’t Miss: Stomach Pains Pregnancy Symptoms
Do You Have Cervical Radiculopathy
Im having numbness and tingling in my hand. Sometimes there is pain that runs down my arm and shoulder. I thought I had carpal tunnel syndrome. Someone told me it could be coming from my neck. What does this mean?
Not all hand numbness is carpal tunnel syndrome. The symptoms you describe are typically caused from a nerve injury or irritation. The nerves that go to your arm start at your neck. If the nerve is being irritated or compressed at your neck, this is called cervical radiculopathy.
What causes cervical radiculopathy? I havent done anything to my neck.
The nerves that go to your arms exit the spinal cord through the spaces between bones in your neck. The bones have cushions between them called discs. A nerve can be compressed if the disc material is pressing on the nerve or if the bones develop spurs from arthritis, making the opening for the nerve small. Sometimes the joints in the spine can become inflamed and cause nerve irritation.
How can I tell if my symptoms are coming from my neck?
Lets perform an experiment to see if we can figure it out.
- Notice what you feel in your arm right now. Is it numb? Tingling? Shooting pains? How intense is it?
- Now, look down at your left foot, then look down at your right foot. Any changes in how you feel? Better, worse or no different?
- Look up as if a bird flew over your left shoulder. Now, do the same for the right shoulder. Any change in how you feel? Better, worse or no different?
Are Any Investigations Required
The diagnosis is a clinical one a small prospective cohort study has shown the effectiveness of clinical examination alone in confirming the diagnosis.4 Electrophysiological testing may support the diagnosis, localize pathology and provide information regarding severity. It is particularly useful when there is diagnostic doubt and as part of a specialist assessment. Based on a well-designed systematic review, specificities of 95% or greater can be achieved with electrophysiological testing.5
Plain radiography of the elbow is indicated where there is a history of arthritis, trauma, malalignment or joint instability. It will usually be undertaken after specialist referral. In patients with a substantial smoking history, chest radiography should be performed to rule out a Pancoast tumour.
Recommended Reading: Kujala Anterior Knee Pain Scale
Who Is At Risk For Cubital Tunnel Syndrome
Some factors that put you at risk for cubital tunnel syndrome include:
Just because youve had these symptoms doesnt mean youll automatically get cubital tunnel syndrome. It just means that youre more at risk than the average person.
Preventing Cubital Tunnel Syndrome
There are various steps you can take to help relieve the symptoms of cubital tunnel syndrome:
- If you frequently use a computer, ensure that your chair isnt too low, and dont rest your elbows on the arms of your chair or your desk
- Avoid activities that keep your arm bent for long periods of time, or be sure to take frequent breaks to stretch your arms
- Dont lean on your elbows or put pressure on the inside of your armfor example, dont drive with your arm resting on the bottom of the open window frame
- When sleeping, wear an elbow pad backwards, or wrap an ace bandage or towel around your straight arm to keep your elbow from bending
If your symptoms persist for more than a few weeks, or if they get worse, see a specialist right away.
You May Like: How To Heal A Sprained Wrist Overnight
Everything You Should Know About Ulnar Nerve Entrapment
It happens quite often that people experience symptoms and either simply ignore them or they believe that it is something else that they are suffering from.
With the Cubital Tunnel Syndrome the first symptoms may be misleading and they may make the patient think that it is nothing serious to worry about.
However, in its later development, this syndrome can seriously affect the state of the patient. If you are interested in finding out more about this medical condition, then do read on.
Common Causes Of Compression
There are several things that can cause pressure on the nerve at the elbow:
- When your bend your elbow, the ulnar nerve must stretch around the boney ridge of the medial epicondyle. Because this stretching can irritate the nerve, keeping your elbow bent for long periods or repeatedly bending your elbow can cause painful symptoms. For example, many people sleep with their elbows bent, which can aggravate symptoms of ulnar nerve compression and cause you to wake up at night with your fingers asleep.
- In some people, the nerve slides out from behind the medial epicondyle when the elbow is bent. Over time, this sliding back and forth may irritate the nerve.
- Leaning on your elbow for long periods of time can put pressure on the nerve.
- Fluid buildup in the elbow can cause swelling that may compress the nerve.
- A direct blow to the inside of the elbow can cause pain, electric shock sensation, and numbness in the little and ring fingers. This is commonly called “hitting your funny bone.”
Recommended Reading: How To Properly Slit Your Wrist
Ease Up On Your Elbow
Cubital tunnel syndrome is treated by avoiding elbow flexion during activities and while sleeping, says Dr. Evans. Wearing an elbow splint at night will prevent you from bending your elbow while youre asleep.
Other things to avoid include resting your elbow on armrests, keeping your elbow bent for extended periods of time, leaning on your elbow, or sitting in a low chair while using a computer. If you talk on the phone a lot, Dr. Evans recommends using a headset instead of holding your phone to your ear.
Early on, nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen , may be taken to reduce swelling around the nerve. Surgery is reserved for severe cases in which compression has caused muscle weakness or damage. It is usually performed as an outpatient procedure with generally good results.
Treatment is aimed at preventing progression, which can be functionally devastating. If treated early, however, cubital tunnel syndrome can be reversed almost fully, says Dr. Evans.
This article originally appeared in Cleveland Clinic Arthritis Advisor.
Understanding Your Neck Nerves
Your spine is made up of 33 small bones called vertebrae, and they stack one on top of the next in a long line commonly known as the spinal column. The bottom section is called the lumbar region, the middle is the thoracic section, and the top part your neck is the cervical region. Each vertebra is numbered, and the cervical section contains C1-C8.
In order to give your extremities feeling and movement, the nerves rooted in your spine branch out from in between your vertebrae and travel throughout your body. You have eight pairs of cervical nerve roots. If you have an injury or develop a condition such as degenerative disc disease, spinal stenosis, or a herniated disc that puts pressure on those cervical nerves, you may feel the effects not only in your neck, but in the places where those nerves travel.
Here are some of the signs and symptoms of cervical radiculopathy:
Also Check: Pregnancy Stomach Symptoms
Mechanisms For Peripheral Nerve Damage
Compression, traction and friction have been implicated in cubital tunnel syndrome.
Compression is usually regarded as the principal mechanism of nerve damage in peripheral neuropathy. Damage may occur either by direct mechanical compression or by compression of the intrinsic blood supply to the nerve, which in turn causes local ischaemia. Mechanical compression forces of 30mm Hg retard blood flow.8 Similarly, compression has been shown to interfere with axonal transport pathways.
Larger fibres containing more myelin are more susceptible to compression than smaller nonmyelinated fibres.9 Compression is most effective at the edge of the compression area in the socalled edge effect.
Preexisting subclinical mechanical compression of the nerve at a different location may increase the susceptibility of the same nerve to compression at a second, more distal, site (the socalled double crush phenomenon.10,11
Previous injuries to the nerve may tether it to the walls of the tunnel, prevent normal sliding and expose it to traction injuries. Similarly, a tight tunnel may predispose the nerve to friction and compression.
Surgical Treatment For Cubital Tunnel Syndrome
All surgical procedures carry risk , and there is debate within the profession as to when we should operate on this condition.
In practice, surgical treatment is offered for more severe cases and where conservative management is deemed to have failed.
Surgical release involves incising longitudinally over the cubital tunnel to release the surrounding retinacular fibres. This procedure must be performed with some care, as damage to small branches of the nerve may lead to painful neuroma. Some surgeons simply decompress the nerve in situ whereas others attempt to mobilise the nerve freely and transpose it anteriorly out of the cubital tunnel.
Nathan et al15 investigated 102 cases of cubital tunnel syndrome treated by simple decompression in situ. His study found that women did better than men, and also noted that postoperative weight gain was a bad prognostic sign. Interestingly, those patients who also had a carpal tunnel release did better, with the possible implication that many cases of cubital tunnel syndrome are complicated by undiagnosed carpal tunnel syndrome.
Read Also: Stomach Hurts After Eating Pineapple
Cubital Tunnel Syndrome And Tardy Ulnar Nerve Palsy
The demographics of patients who required operative release of the carpal tunnel or cubital tunnel were compared by Zhang et al. The two groups were found to be dissimilar, with the exception of those with diabetes. Patients with cubital tunnel release often had a history of trauma to the anatomic site of the cubital tunnel. Patients with carpal tunnel release were older and more often female, had higher body mass indexes, and had concomitant hand tendinopathies. The diabetic population was found to have both procedures more often. Other studies have shown male gender to be a risk factor for cubital tunnel syndrome.
Before surgical treatment, careful preoperative evaluation and EMG are recommended. The surgical treatment of cubital tunnel syndrome includes simple decompression , medial epicondylectomy, and anterior transposition of the ulnar nerve into a subcutaneous, intramuscular, or submuscular bed. Taniguchi et al. reported good-to-excellent results in 14 of 17 patients treated with simple decompression through a small incision. Goldfarb et al. reported that only 7% of 56 patients had recurrent symptoms postoperatively.
David C. Preston, in, 2003
What Causes Cubital Tunnel Syndrome
Your healthcare provider might not be able to narrow down the exact cause of your cubital tunnel syndrome. Possible causes include:
- Anatomy: Over time, the soft tissues over your ulnar nerve might get thicker, or there might be extra muscle. Both of those issues can stop your nerve from working right and cause cubital tunnel syndrome.
- Pressure: A seemingly simple use of your elbow, like leaning it on an armrest, can press on the ulnar nerve. When the nerve gets compressed, you might feel your arm, hand, ring finger and pinky finger fall asleep.
- Snapping: Your ulnar nerve might not stay where its supposed to. It might snap over the medial epicondyle when you move it. Snapping it repeatedly irritates the nerve.
- Stretching: If you bend your elbow for a long time, like when you sleep, you might overstretch the nerve. Too much stretching could result in cubital tunnel syndrome.
Read Also: Ra Symptoms In Neck
What Diagnoses Should Be Considered
The likely diagnosis is cubital tunnel syndrome. Other diagnoses to consider include cervical radiculopathy or compression of the ulnar nerve at another level . Carpal tunnel syndrome is a more common compression neuropathy, but it does not usually affect the little finger, and any muscle wasting would involve the thenar eminence. Cubital tunnel syndrome is the second most common compression neuropathy. Its incidence is reported as 23.2 and 18.9 per 100 000 per year for men and women, respectively.1
How Can I Reduce My Risk Of Cubital Tunnel Syndrome
Although it might not be possible to prevent cubital tunnel syndrome, there are a few ways you can help reduce your risk:
- Avoid leaning on your elbow.
- Avoid putting pressure on the inside of your arm.
- Don’t rest your elbow on your computer chair armrest if you use it frequently. Keep your chair high.
- Sleep with your elbow straight.
- Stay away from anything that makes you bend your arm for a long time.
Recommended Reading: How To Workout With A Broken Wrist