What Is Cubital Tunnel Syndrome?
Cubital tunnel syndrome is caused by increased pressure or stretching of the ulnar nerve at the elbow, also known as the “funny bone.” This condition is characterized by tingling or numbness in the ring and small fingers, pain in the forearm, and/or general weakness in the hand. These symptoms frequently happen during activities where the elbow is bent, such as talking on the phone or driving a car. Over time, this can make it difficult to grasp or pinch objects, make a tight fist, or do simple tasks like buttoning clothes. In later stages, patients may notice complete wasting of the small muscles in the hand. Fortunately, many symptoms of cubital tunnel syndrome can be minimized or eliminated with treatments guided by our team of reconstructive hand surgeons in Long Island and New York City. The condition is often initially addressed with nonsurgical treatments, such as therapy and activity modification. No matter the severity of your symptoms, we aim to provide you with the expert care that can help you find relief and regain hand and finger function.
Signs & Symptoms
Cubital tunnel syndrome characteristically affects the ring finger and small finger (pinky), but symptoms can also extend to the hand, forearm, and elbow. Signs of the condition may include:
- Tingling, pins and needles sensations, electric shocks
- Dull or burning pain
- Loss of sensation
- Inability to pinch
- A weak grip or general feeling of weakness
These symptoms can arise during certain movements, especially activities where the elbow is bent. The symptoms will initially come and go, but will eventually be felt at all times as the condition worsens. The diagnosis of cubital tunnel is clinical, based on your medical history and physical exam findings. Our reconstructive hand surgeons can examine your symptoms and utilize an array of approaches to determine the most effective course of treatment for your case.
Causes
The ulnar nerve is one of the three main nerves of the arm, supplying feeling to the ring and pinky fingers, as well as controlling the movement of the small muscles of the hand. The ulnar nerve is located close to the skin’s surface and runs behind the inner elbow in a tight compartment called the cubital tunnel. Certain stressors that impact this nerve over a long period of time can lead to cubital tunnel syndrome. In general, causes may include:
- Pressure: Because this nerve has little padding over it, certain movements can create tension on the nerve and cause the affected areas to experience a pins-and-needles sensation, or “fall asleep.” Leaning the elbow on a hard surface or bending the elbow for an extended length of time are common motions that can eventually cause symptoms associated with cubital tunnel syndrome.
- Stretching: Keeping the elbow bent during sleep, while talking on the phone, or during other activities can stretch the ulnar nerve, causing increased pressure and leading to cubital tunnel syndrome if these actions are consistently repeated.
- Anatomy: A person’s natural anatomy can sometimes prevent the ulnar nerve from working properly. For some individuals, moving the elbow forces the nerve to snap across a bony bump and the repeated snapping can cause inflammation or irritability over time. For others, abnormal bone growth or intense physical activity can trigger symptoms.
Treatment
Many treatments may first involve refraining from the motions that are likely to cause symptoms. This may involve:
- Activity modification—Patients are instructed to avoid elbow-flexing activities, such as talking on the phone, typing on a computer with the elbows bent, or resting the elbow in the center console while driving.
- Wearing an elbow pad or splint—Using a splint, especially while sleeping, can limit elbow flexion and decrease stress to the nerve. An elbow pad may also be utilized during daytime hours to similarly immobilize the elbow and avoid direct pressure on the ulnar nerve.
- Surgery—When conservative treatment proves to be ineffective or patients present with muscle loss, the recommended treatment is surgery. Surgery involves a small incision at the inner elbow with release of the nerve at multiple points of compression. Usually, the nerve can be left in its native position. This is known as an “in situ” decompression. Occasionally, the nerve is not stable in this position and requires relocation from behind the elbow to the front of the elbow. The nerve can be placed under the skin or under the forearm muscles, depending on the specific case.
Recovery from surgery averages three to six weeks. Most patients are given a home exercise program and some will benefit from supervised hand therapy. At the Institute for Hand Surgery at New York Plastic Surgical Group, a Division of Long Island Plastic Surgical Group, we can develop a personalized treatment plan to determine the most beneficial course of action for your unique condition. While recovery may be gradual, our reconstructive hand surgeons can take the necessary steps to help you regain maximum function of the affected areas.
