What causes Cubital Tunnel Syndrome?
Pressure on the ulnar nerve at the elbow can develop in several ways. The nerve is positioned right next to the bone and has very little padding over it, so even the smallest pressure on this “funny bone” can put pressure on the nerve. For example, if you lean your arm against a table on the inner part of the elbow, your arm may fall asleep and be painful from sustained pressure on the ulnar nerve. The numbness and pain may become more persistent, if this occurs repetitively. In some patients, the ulnar nerve at the elbow clicks back and forth over the bony bump (medial epicondyle) as the elbow is bent and straightened, and this nerve may be significantly irritated, if this occurs repetitively.
Additionally, holding the elbow in a bent position for a long time can create excessive pressure on the ulnar nerve, which stretches the nerve across the medial epicondyle. Many times, such sustained bending of the elbow tend to occur during sleep. Sometimes the connective tissue over the nerve becomes thicker, or there may be variations of the muscle structure over the nerve at the elbow that cause pressure on the nerve. Cubital tunnel syndrome can occur if the pressure on the nerve is significant and sustained long enough to disturb the way in which the ulnar nerve works.
Signs and symptoms of Cubital Tunnel Syndrome
Cubital tunnel syndrome symptoms usually include pain, numbness, and/or tingling, which often occurs in the ring and little fingers. These symptoms are usually felt when there is pressure on the nerve with actions like repetitive elbow bending and straightening or sitting with the elbow on an arm rest. Usually, symptoms will be felt when the elbow is held in a bent position for an extended period of time, such as when holding the phone, or while sleeping. Some patients may experience a tendency to drop things, occasional clumsiness, and/or weakness while pinching. In much more severe cases, sensation may be lost and the muscles in the hand may lose bulk and strength.
Diagnosis of Cubital Tunnel Syndrome
Dr. Setty will assess the pattern and distribution of your symptoms, while examining for changes in sensation, irritability of the nerve to tapping and/or bending of the elbow, and/or muscle weakness. Other medical conditions may need to be evaluated such as thyroid disease or diabetes. The diagnosis of cubital tunnel syndrome and its relative stage of severity may be confirmed with a test called electromyography (EMG) and/or nerve conduction study (NCS). This test also checks for other possible nerve problems, such as a pinched nerve in the neck, which may cause similar symptoms.
Treatment of Cubital Tunnel Syndrome
Symptoms may sometimes be relieved without surgery, particularly if the EMG/NCS testing shows that the pressure on the nerve is minimal. Several of the non-invasive recommendations that may help to alleviate CTS symptoms, include:
- Changing the patterns of elbow use may significantly reduce the pressure on the nerve.
- Avoiding putting your elbow on hard surfaces may help
- Wearing an elbow pad over the ulnar nerve and “funny bone”
- Keeping the elbow straight at night with a splint
- A session with a therapist to learn ways to avoid pressure on the nerve
However, surgery may be needed to relieve the pressure on the nerve when symptoms are severe or do not improve. Many surgeons will recommend shifting the nerve to the front of the elbow, which relieves pressure and tension on the nerve. Furthermore, the nerve may be placed under a layer of fat, under the muscle, or within the muscle. Some surgeons may recommend trimming the bony bump (medial epicondyle).
Following surgery, the recovery will depend on the type of surgery that was performed. Restrictions on lifting and/or elbow movement may be recommended, and therapy may be necessary. The numbness and tingling may improve quickly or slowly, and it may take several months for the strength in the hand and wrist to improve. Cubital tunnel symptoms may not completely resolve after surgery, especially in severe cases.
For more information on Cubital Tunnel Syndrome and ways to treat it, please set up a consultation with Dr. Setty today!