The Tingling Behind Cubital Tunnel Syndrome

Symptoms and diagnosis for Cubital Tunnel Syndrome
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By Neurosurgery Singapore

Cubital Tunnel Syndrome Main

What is a cubital tunnel syndrome? 

The cubital tunnel is located in the elbow and is a 4-millimeter passageway between the bones and tissue.

It encases the ulnar nerve, one of the nerves that supplies feeling and movement to the arm and hand. The ulnar nerve runs from the neck to the shoulder, down the back of the arm, around the inside of the elbow and ends at the hand in the fourth and fifth fingers. Due to the narrow opening of the cubital tunnel, it can be easily injured or compressed through repetitive activities or trauma.

Cubital tunnel syndrome is the second most common peripheral nerve entrapment syndrome next to carpal tunnel. It can cause symptoms in the arm and hand including pain, numbness, and muscle weakness, particularly in the areas controlled by the ulnar nerve like the ring and pinky finger.

Causes of compression include daily habits like leaning on your elbows for long periods of time, sleeping with your arms bent, or repetitive movement of the arm. Direct trauma to the inside of the elbow, like when you hit your funny bone, can also cause symptoms of ulnar nerve pain.

What are some symptoms of a cubital tunnel syndrome?

Most people with cubital tunnel syndrome experience symptoms that may include:

  • numbness, pain, and weakness in the arm, forearm, and fingers
  • weakened or reduced grip
  • waking at night from pain or numbness in the hands or fingers, especially the pinky and ring fingers
  • having difficulty bending and straightening the fingers
  • difficulty manipulating things with the hands or fingers
  • muscle loss at the base of the small fingers

The symptoms of cubital tunnel syndrome usually get much worse when the elbow is bent for a long time or compressed.

“Carpal tunnel is compression of the median nerve at the wrist, while cubital tunnel is compression of the ulnar nerve at the elbow. Both conditions can cause pain, numbness and tingling. Typically, carpal tunnel syndrome causes symptoms in the thumb, index and long fingers. “

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What types of diagnosis?

We highly recommend seeking professional help instead of self diagnosis to identify the issue and enable faster recovery. Our Specialist will discuss your medical history and general health. He may also ask about your work, your activities, and what medications you are taking.

After discussing your symptoms and medical history, our doctor will examine your arm and hand to determine which nerve is compressed and where it is compressed. Some of the physical examination tests our doctor may do include:

  • Tap over the nerve at the funny bone. If the nerve is irritated, this can cause a shock into the little finger and ring finger (Tinel’s sign) — although this can happen when the nerve is normal as well.
  • Check whether the ulnar nerve slides out of normal position when you bend your elbow.
  • Move your neck, shoulder, elbow, and wrist to see if different positions cause symptoms.
  • Check for feeling and strength in your hand and fingers.

X-rays. These imaging tests provide detailed pictures of dense structures, like bone. Most causes of compression of the ulnar nerve cannot be seen on an x-ray. However, our Specialist may recommend to take x-rays of your elbow or wrist to look for bone spurs, arthritis, or other places that the bone may be compressing the nerve.

Nerve conduction studies. These tests can determine how well the nerve is working and help identify where it is being compressed.

Nerves are like “electrical cables” that travel through your body carrying messages between your brain and muscles. When a nerve is not working well, it takes longer for it to conduct.

During a nerve conduction test, the nerve is stimulated in one place and the time it takes for there to be a response is measured. Several places along the nerve will be tested and the area where the response takes too long is likely to be the place where the nerve is compressed.

Nerve conduction studies can also determine whether the compression is also causing muscle damage. During the test, small needles are put into some of the muscles that the ulnar nerve controls. Muscle damage is a sign of more severe nerve compression.

Possible treatment methods?

Cubital tunnel syndrome often can be managed conservatively, especially if electromyography reveals that there is minimal pressure on the ulnar nerve.

Mild cases of cubital tunnel syndrome often respond to physical therapies such as:

  • Avoidance of undue pressure on the elbow during daily activities
  • Wearing a protective elbow pad over the “funny bone” during daily activities
  • Wearing a splint during sleep to prevent over-bending of the elbow

 

In cases where splinting doesn’t help or nerve compression is more severe, about 85% of patients respond to some form of surgery to release pressure on the ulnar nerve. These include surgeries that:

  • Result in simple decompression of the ulnar nerve
  • Shift the nerve to the front of the elbow
  • Move the nerve under a layer of fat, under the muscle, or within the muscle
  • Trim the bump of the inner portion of the elbow — the medial epicondyle — under which the ulnar nerve passes

If you undergo surgery for cubital tunnel syndrome, recovery may involve restrictions on lifting and elbow movement, and rehabilitation therapy. Although numbness and tingling may or may not quickly improve, recovery of hand and wrist strength may take several months.

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