Cubital Tunnel syndrome

Cubital tunnel syndrome is a common condition where one of the major nerves to the forearm and hand (the “ulnar nerve”) gets compressed as it passes along the inner side of the elbow.  Irritation of the “funny bone” nerve can cause numbness or tingling into the ring and small finger. This oftentimes happens at night when sleeping, and can severely disrupt the quality of their sleep. It can also result in the hand feeling week and clumsy.

Common causes

  • Pressure on the nerve

    • Arm rests on chairs

    • Console of car when driving

  • Keeping the elbow flexed for extended periods of time such as when

    • Sleeping

    • Talking on the phone

  • Abnormal anatomy

    • Scarring

    • Extra muscle present

    • Mobile nerve that snaps over the elbow bone when flexing the elbow

 

Diagnosis

  • Cubital tunnel syndrome can oftentimes be diagnosed by talking with your doctor and having them examine your hand and arm. Occasionally a nerve test (EMG or nerve conduction study) can be used to assess the function of the nerve and determine if its being compressed.

 

Non-surgical treatment

  • Minimize irritation of the ulnar nerve

    • Avoid pressure on the "funny bone" -(e.g. arm rests of chairs, leaning on console of car)

    • Limit prolonged periods of elbow flexion

  • Wear a splint at night to keep the elbow straight

Keeping the elbow straight while sleeping minimizes tension on and irritation of the ulnar nerve. A homemade splint can be made with a towel loosely wrapped around the elbow and held in place with an ace bandage or tape.

  • Ulnar nerve gliding exercises (see below)

Ulnar nerve gliding exercises. While keeping your head in a neutral position: 1) Begin with your arm out, palm side of the hand facing up. 2) Bend the elbow toward you, palm side facing you. 3) Rotate the palm of your hand outward and bend your wrist so that the fingers are pointing towards you. 4) Twist your wrist so that the palm of your hand is now facing upward. 5) While your wrist remains bent, stretch out your arm into a straight position, with your fingers bent towards the floor. Hold each position for 5 seconds, repeat series 3-5 times.

Surgical treatment

Occasionally, surgery may be needed to either release the nerve. Typically an incision is made along the inside of the elbow.  The "roof" of the tunnel is released, which eliminates compression of the nerve.

More rarely, if symptoms are associated with the ulnar nerve snapping or moving along the inside of the arm when then elbow is bent, the nerve may be surgically moved to the front of the elbow.

Absorbable sutures are placed underneath the skin, and Dermabond (medical grade "Super Glue") is used to seal the incision. A bandage is placed which remains in place for 3 days.

The hand can be used for normal light activities immediately, and you can get the incision wet once the bandage is removed. More demanding activities (e.g. lifting weights, gardening, manual labor) should be avoided until the skin heals (~10 days).

Improvements in numbness and tingling can be immediate or very gradual.  Optimal nerve recovery may take several months after surgery, and if symptoms are severe, they not completely go away.