Occasional numbness and tingling occur during activities involving prolonged elbow bending. Symptoms typically resolve with rest or position changes, and nerve damage is minimal.
Cubital Tunnel Syndrome
Dr Jacqueline Tan
MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)
Cubital tunnel syndrome occurs when the ulnar nerve, which runs along the back of the elbow behind the “funny bone” (medial epicondyle), becomes compressed or irritated. The nerve passes through a narrow passageway called the cubital tunnel, formed by bone, muscle, and ligaments, and extends to the ring and little fingers.
This condition leads to pain, numbness, or loss of sensation in the affected area, often requiring treatment to prevent progression.
Symptoms of Cubital Tunnel Syndrome
Symptoms of cubital tunnel syndrome often start gradually but can worsen over time. Common symptoms include:
- Numbness in Ring and Small Fingers: Intermittent or constant numbness, which tends to worsen when the elbow is bent for extended periods or during sleep.
- Hand Weakness: Difficulty with grip strength and fine motor tasks, often causing patients to drop objects or struggle with everyday activities like using utensils.
- Aching Elbow Pain: A dull, persistent ache on the inner side of the elbow that may radiate down to the forearm.
- Tingling Sensations: A “pins and needles” feeling along the nerve pathway, commonly triggered by elbow movement or pressure.
- Muscle Wasting: In advanced cases, visible shrinking of muscles in the hand, particularly between the thumb and index finger, indicating prolonged nerve compression.
Causes and Risk Factors
Cubital tunnel syndrome may be caused by a combination of factors, including the following:
- Repetitive Bending and Extension: Frequent elbow movement causes the ulnar nerve to stretch and slide, leading to irritation and inflammation.
- Anatomical Anomalies: Bone spurs, fibrous bands, or naturally shallow cubital tunnels can contribute to nerve compression.
- External Pressure: Resting on elbows or repetitive pressure from external factors, such as cysts or growths, increases the likelihood of irritation.
- Previous Elbow Injury: Fractures, dislocations, or other trauma can alter the nerve’s pathway, making it more susceptible to compression.
- Occupational and Lifestyle Factors: Jobs or habits requiring repetitive elbow flexion, such as typing or using tools, can exacerbate the condition.
Stages of Cubital Tunnel Syndrome Progression
Cubital tunnel syndrome varies in severity, progressing through three stages.
Mild Compression
Moderate Compression
Numbness, tingling, and hand weakness become more frequent and may not improve with position changes. Early signs of muscle weakness may appear, though damage remains partially reversible.
Severe Compression
Persistent numbness, noticeable hand weakness, and visible muscle wasting develop, significantly affecting hand function. Without intervention, irreversible nerve damage is likely.
Diagnostic Methods
Physical Examination
The doctor evaluates muscle strength, sensation, and visible signs of muscle wasting. Tests like Tinel’s sign or the elbow flexion test may be used to recreate symptoms and locate nerve compression.
Electrodiagnostic Studies
Nerve conduction tests and electromyography (EMG) assess the speed and strength of nerve signals and help identify the compression site and severity. These tests also rule out related conditions, such as a pinched nerve in the neck.
Imaging Tests
X-rays can reveal structural abnormalities like bone spurs, while MRI or ultrasound scans provide detailed views of soft tissue issues contributing to nerve compression.
Treatment Options
Treatment options for cubital tunnel syndrome focus on alleviating nerve pressure, restoring function, and preventing long-term damage to the hand and arm.
Non-Surgical Treatment
Activity Modification
Avoid activities that involve prolonged elbow bending, such as resting on elbows or repetitive motions like typing. Ergonomic changes, such as adjusting workstations and using hands-free phone setups, can help reduce strain on the nerve. Patients are also advised to avoid applying pressure to the inner elbow during daily activities or sleep.
Splinting
Night splints keep the elbow straight to minimise pressure on the ulnar nerve during sleep. In some cases, splints may also be used during the day for specific activities to prevent nerve irritation.
Physical Therapy
Physical therapists design customised exercises that improve nerve mobility, such as nerve gliding techniques, and enhance joint flexibility to prevent stiffness. They also educate patients on maintaining proper posture and ergonomics to reduce strain on the ulnar nerve and improve long-term outcomes.
Medications
Non-steroidal anti-inflammatory drugs are often prescribed to alleviate pain and reduce inflammation around the ulnar nerve. While these medications do not address the underlying compression, they can improve comfort and functionality during the healing process.
Surgical Treatment
Ulnar Nerve Decompression
This procedure involves releasing tight structures around the ulnar nerve within the cubital tunnel, creating more space and reducing compression. It is less invasive and suitable for patients with mild to moderate nerve compression. Recovery is typically quicker compared to other surgical options.
Nerve Transposition
In cases where the ulnar nerve is significantly irritated by its position behind the elbow, it is moved to a new location in front of the elbow. This reduces tension during movement and provides a more stable environment for the nerve. Recovery may take longer but is often necessary for severe cases.
Medial Epicondylectomy
When the bone structure of the medial epicondyle contributes to nerve compression, a portion of it is removed to create more space. This procedure is sometimes combined with decompression or transposition for optimal results, especially in patients with anatomical variations.
Prevention and Management
Preventive measures can reduce the risk of cubital tunnel syndrome and help manage early symptoms. Take regular breaks from repetitive elbow movements, avoid direct pressure on the elbows, and use ergonomic workstations with padded supports. Regular exercise to maintain joint flexibility and strengthen supporting muscles is helpful, while keeping the elbows warm in cold weather can ease discomfort and prevent flare-ups.
Frequently Asked Questions
Are athletes at higher risk of developing cubital tunnel syndrome?
Yes, athletes engaged in sports that involve repetitive arm and elbow movements, such as baseball, tennis, or golf, are more susceptible due to increased strain on the ulnar nerve.
Can poor posture contribute to cubital tunnel syndrome?
Yes, poor posture, such as slouching or improper arm positioning during activities like typing or using a computer, can increase strain on the ulnar nerve and contribute to symptom development.
What is the recovery process like after surgery?
Recovery after surgery typically includes a period of rest, followed by physical therapy to restore strength and flexibility. Patients gradually return to regular activities over time, with noticeable improvements often occurring within 3 to 6 months, depending on the severity of the condition.
Dr Jacqueline Tan
MBBS (SG)
MRCS (Edin)
MMed (Surgery)
FAMS (Hand Surgery)
Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.
- Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
- Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
- Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
- Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.
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