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Orthopedic Surgery

Cubital Tunnel Syndrome (Ulnar Neuropathy)

Condition • By Biraj Patel

In the realm of orthopedic mysteries, cubital tunnel syndrome takes center stage as a condition that often operates undercover, quietly affecting our daily lives. It's the silent saboteur of the elbow, ready to disrupt our routines with symptoms that may seem innocuous at first but can escalate into a formidable challenge. In this article, we embark on a journey to demystify cubital tunnel syndrome, uncovering its causes, deciphering its symptoms, and unraveling a tapestry of treatment options, all under the guidance of the best orthopedic surgeons in the field.

What is cubital tunnel syndrome?

Cubital tunnel syndrome, also known as ulnar neuropathy, is a nerve compression disorder that occurs when the ulnar nerve gets entrapped or compressed as it passes through the cubital tunnel. This tunnel is a narrow passageway on the inside of the elbow, often referred to as the “funny bone.”

What causes cubital tunnel syndrome?

The causes of cubital tunnel syndrome can be diverse, from repetitive bending of the elbow to sustained pressure on the ulnar nerve. Some common factors include:

Repetitive or prolonged activities that require the elbow to be bent or flexed
Prior fracture or dislocation of the elbow
Bone spurs or arthritis of the elbow
Swelling of the elbow joint
Cysts near the elbow joint

Certain risk factors can increase the likelihood of developing cubital tunnel syndrome, such as:

Age
Gender (more common in men)
Obesity
Diabetes
Thyroid disease

What are the cubital tunnel syndrome symptoms and signs?

Cubital tunnel syndrome can be rather sneaky in its approach, with symptoms developing gradually. Recognizing these signs is crucial to early intervention and effective treatment.

Numbness and tingling: Typically in the ring and little fingers.
Weakening grip: Difficulty in holding objects or a tendency to drop things.
Pain: This can range from a dull ache to sharp, shooting pains.
Clumsiness: A general feeling of clumsiness due to hand weakness.
Difficulty straightening the arm: Elbow stiffness can be a sign.

Diagnosing cubital tunnel syndrome

A doctor can diagnose cubital tunnel syndrome by taking a full medical history, evaluating symptoms, and performing a physical exam. In some cases, nerve testing may be done to determine the severity of the compression and how much muscle is being affected.

Cubital tunnel syndrome test

The nerve conduction study is a crucial test to determine the extent of nerve involvement and severity of the condition.

It helps orthopedic specialists and healthcare professionals determine the extent of ulnar nerve compression within the cubital tunnel, a passageway on the inside of the elbow. This test is typically conducted in a clinical setting and is essential for guiding treatment decisions.

The primary method for diagnosing cubital tunnel syndrome is through Nerve Conduction Studies (NCS) and Electromyography (EMG). Here's a breakdown of how these tests are performed.

Nerve Conduction Study (NCS)

This part of the test primarily focuses on assessing the speed and strength of nerve impulses as they travel along the ulnar nerve. The patient will be comfortably seated, and the test involves the following steps:
Electrodes are attached to specific points along the ulnar nerve's pathway, typically at the wrist, below the elbow, and near the shoulder.
Small electrical pulses are applied to one electrode to stimulate the ulnar nerve.
The time it takes for the electrical impulse to travel between electrodes is recorded, providing data on nerve conduction velocity.

Electromyography (EMG)

This aspect of the test involves assessing the electrical activity of muscles innervated by the ulnar nerve. The process includes:

A thin, sterile needle electrode is inserted into specific muscles, typically those controlled by the ulnar nerve, in the forearm and hand.
The patient is instructed to contract these muscles gently.
The EMG machine records the electrical activity within the muscles, detecting abnormalities or signs of nerve compression.

How to prevent cubital tunnel syndrome

To prevent cubital tunnel syndrome from recurring, it is important to avoid activities that cause symptoms and to maintain good posture.

Other secondary prevention techniques include:

Avoid resting elbows on a hard surface
Warm up before any activity that requires repetitive movements
Wearing a protective pad over the elbow

Cubital tunnel syndrome treatment

The good news is that cubital tunnel syndrome is treatable, and the choice of treatment depends on the severity of the condition and individual patient needs. Here are the main approaches.

Conservative management

Lifestyle modifications: Avoiding activities that exacerbate symptoms, such as prolonged elbow bending.

Cubital tunnel syndrome brace: Wearing a brace or splint to keep the elbow in a slightly bent position.

Cubital tunnel syndrome exercises: Physical therapy exercises can help strengthen the affected muscles and improve nerve mobility. You can check out some of the exercises below.

Cubital tunnel syndrome exercises

It's essential to perform these exercises regularly but gently. If you experience increased pain, numbness, or any discomfort, stop the exercise and consult your healthcare provider.

Elbow flexor stretch

Stand or sit up straight.
Extend your affected arm in front of you with your palm facing up.
Use your other hand to gently pull back the fingers of your affected hand, extending your wrist and fingers.
Hold the stretch for 15–30 seconds and repeat 2–4 times.

Elbow extensor stretch

Extend your affected arm in front of you with your palm facing down.
Use your other hand to gently push the back of your hand, extending your wrist and fingers.
Hold the stretch for 15–30 seconds and repeat 2–4 times.

Wrist flexor and extensor strengthening

Use a lightweight dumbbell or a resistance band.
For wrist flexor strengthening, hold the weight with your palm facing up and curl your wrist upwards.
For wrist extensor strengthening, hold the weight with your palm facing down and curl your wrist downwards.
Perform 2–3 sets of 10–15 repetitions for each exercise.

Pronation and supination exercise

Hold a light object, like a small dumbbell or a hammer, with your arm extended.
Rotate your forearm outward (supination) and then inward (pronation).
Perform 2–3 sets of 10–15 repetitions for each direction.

Ulnar nerve gliding exercise

Begin with your arm extended.
Slowly bend your elbow while keeping your wrist straight.
As you bend your elbow, bend your neck to the opposite side to create tension in the ulnar nerve.
Hold this position for a few seconds, then release and repeat.

Grip strengthening

Squeeze a soft stress ball or a therapy putty.
Focus on gently strengthening your grip without causing pain.

Range of motion exercises

Gently flex and extend your elbow, wrist, and fingers to maintain or improve joint mobility.

Nerve gliding exercise

Start with your arm extended and your palm facing up.
Slowly bend your elbow while keeping your wrist straight.
As you bend your elbow, turn your palm to face down.
Repeat this motion to glide the ulnar nerve.

Medical Interventions

Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation.

Corticosteroid injections: These can be effective in reducing swelling and pain.

Cubital tunnel syndrome surgery

When conservative treatments fail or the condition is severe, surgical intervention may be necessary. Surgery involves releasing the compressed nerve or repositioning it to relieve pressure.

Discuss cubital tunnel syndrome treatment with the best orthopedic surgeons on PreferredMD

Cubital tunnel syndrome is a treatable condition, and the earlier it is addressed, the better the outcomes. If you suspect you have this condition, don't hesitate to consult the best orthopedic surgeon to explore the most suitable treatment options. Your journey to recovery and improved quality of life starts with seeking professional guidance.

Remember, knowledge is power, and when it comes to orthopedic wellness, we've got you covered! Stay tuned for more insightful articles on health and well-being.