Cubital Tunnel Syndrome - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Cubital tunnel syndrome occurs when the ulnar nerve that travels through the neck and down to the hand can be constricted at several sites resulting in nerve compression. Areas beneath the collarbone or at the wrist are prone to entrapment when the ulnar nerve becomes compressed or irritated. The inside part of the elbow is the most common place for compression of the nerve behind.

Course of the Ulnar Nerve Through the Elbow Joint:

The ulnar nerve traverses through the cubital tunnel. It runs under a bump of bone inside the elbow. This is known as the medial epicondyle of the humerus. It is a part of the longest bone of the upper extremities that ends in the funny bone. This spot where the nerve runs under the medial epicondyle is commonly referred to as the "funny bone," where the nerve is close to the skin, and sudden bumping causes a shock-like sensation.

The nerve then travels under muscles on the inside of the forearm and into the hand about the palm along the surface of the little finger. Finally, the nerve enters the hand traveling through Guyon's canal.

The ulnar nerve supplies innervation to the little finger and half of the ring finger alongside the tiny muscles of the hand responsible for fine movements and some muscles in the forearm that help make a firm grip.

What Causes Cubital Tunnel Syndrome?

Cubital tunnel syndrome may happen when the elbows are bent when performing actions such as pulling, reaching, lifting, leaning on the elbow a lot, or any injuries to the area.

Cubital tunnel syndrome can also result from other conditions such as arthritis, bone spurs, and previous fractures or dislocations of the elbow. In several cases, the underlying cause may be obscure or unclear.

The Common Causes of Ulnar Nerve Impingement:

Several events can cause pressure on the nerve at the elbow region, as mentioned below;

• Bending the elbow causes the ulnar nerve to stretch around the bony ridge of the medial epicondyle. This stretching can cause irritation to the ulnar nerve.

• Keeping the elbow bent for prolonged periods or repeatedly turning movements of the elbow can cause painful symptoms such as sleeping with the elbows bent, which can aggravate symptoms of ulnar nerve compression and cause numbness to the fingertips.

• The nerve may also slide out from behind the medial epicondyle when the elbow is bent.

• Over time, the sliding back-and-forth movements may irritate the nerve.

• Leaning on the elbow for prolonged periods can put pressure on the nerve.

• A buildup of fluids in the elbow can cause swelling that causes nerve compression.

• Traumatic damage to the inside part of the elbow can cause pain, electric shock sensation, and numbness in the little and ring fingers, called "hitting the funny bone."

Possible Risk Factors Behind Ulnar Nerve Impingement:

Some factors put an individual more at risk for developing cubital tunnel syndrome, which include the following;

• Fracture or dislocation of the elbow joint.

• Presence of bone spurs.

• Arthritis of the elbow joint.

• Swelling of the elbow joint results in pressure on the nerve.

• Cysts or tumors near the elbow joint may impinge on the nerve.

• Repetitive strain is caused by daily activities that require the elbow to be bent or flexed continually or for prolonged periods.

How Does an Ulnar Nerve Compression Feel?

The most common symptoms caused by cubital tunnel syndrome are as follows;

• Numbness and tingling sensations of the hand, the ring finger, and the little finger, while bending the elbow.

• Numbness and tingling sensation.

• Pain in hand.

• Weakened grip and clumsiness caused by muscle weakness in the affected arm and hand

• Excruciating or dull pain on the inside portion of the elbow.

• The symptoms may mimic other health conditions or problems such as medial epicondylitis or a golfer's elbow.

How Is Cubital Tunnel Syndrome Diagnosed?

A complete medical history of the patient is recorded, and a physical examination is done along with diagnostic tests as mentioned below;

• Nerve Conduction Tests: The test measures the velocity of the signals traveling down a nerve to locate the site of compression or constriction.

• X-rays: X-rays are done to look at the bones of the elbow and detect the presence of arthritis or bone spurs in the elbow.

• Electromyogram (EMG): A test for nerve and muscle function may be used to test the forearm muscles controlled by the ulnar nerve. Any anomaly may sign that there is a problem with the ulnar nerve.

What Are the Treatment Modalities for Cubital Tunnel Syndrome?

Cubital tunnel syndrome is addressed by first stopping the activity responsible for the problem. The usual treatment modalities include the following;

• Rest.

• Stoppage of activities that aggravate the condition.

• Restrict bending of the elbow for prolonged periods or repetitively.

• Application of splints or foam elbow braces at night

• Limit movements.

• Using an elbow pad

• Protection against chronic irritation from hard surfaces

• Anti-inflammatory medicines.

• Nerve gliding exercises and physical therapy.

If these treatments do not work, a surgical option may be considered.

Rate of Success for Surgical Treatment:

The results of surgery are generally satisfactory. All surgery methods have a similar success rate for routine cases of nerve compression. However, in case of badly damaged nerves or muscle wasting, the nerve may not return to normalcy, with persistent symptoms even after the surgery. Therefore, nervous recovery takes a prolonged period. Determining the nerve recovery after surgery is also immediately inconclusive in severe cases.

How to Prevent Nerve Compression and Cubital Tunnel Syndrome?

In order to prevent cubital tunnel syndrome, the following measures may be taken;

• Keeping the arms flexible and strong with regular exercise.

• Avoid too much leaning on the elbows, especially against hard surfaces.

• Warm-ups before heavy training or using components for sports or other repetitive movements.

Home Remedies to Relieve Cubital Tunnel Syndrome Symptoms:

There are several home remedies to help relieve symptoms. However, if the symptoms interfere with daily activities or last more than a few weeks, a doctor should be consulted.

• Avoid activities that require keeping the arm bent for prolonged periods.

• Ensure that the chair height is adequate in the case of regular computer use.

• Resting the elbow on the armrest of chairs should be avoided.

• Avoid leaning on the elbow, especially against hard surfaces

• Avoid pressuring the inside of the arm.

• Arm must not be kept resting on the open window of a car while driving.

• Keeping the elbow straight at night when sleeping.

• Wrapping a towel around the straight elbow or wearing an elbow pad backward while sleeping at night.

When Should Professional Help Be Sought?

Medical opinion is sought when the following occurs;

• Excruciating pain.

• Trouble in movements that affect everyday activities.

• Pain does not eradicate or worsen even after treatment.

• Numbness and tingling sensations.

• Weakness in the arm or hand.

Conclusion

The ulnar nerve follows the cubital tunnel that runs under a bump of bone inside the elbow. Cubital tunnel syndrome may happen when the elbows are bent when performing actions such as pulling, reaching, lifting, leaning on the elbow a lot, or any injuries to the area. Cubital tunnel syndrome is addressed by first stopping the activity responsible for the problem.