Cubital Tunnel Syndrome

What is cubital tunnel syndrome?

Cubital tunnel syndrome is compression of the ulnar nerve (funny bone nerve) on the inside or medial side of the elbow. The ulnar nerve begins in the neck at the C8-T1 vertebrae and travels behind the elbow before it supplies feeling to the small and half the ring finger and provides motor strength to the small muscles of the hand. The ulnar nerve is critical to hand function supplying the muscles that control pinch, and fine grasp. The ulnar nerve is important to allowing us to buttoning shirts and things like tying shoes.

How does cubital tunnel syndrome occur?

The ulnar nerve sits in a vulnerable position behind the medial epicondyle. When the elbow flexes, the ulnar nerve is put under pressure. The ulnar nerve can be compressed by a structure known as Osborne’s Ligament, the flexor carpi ulnar is fascia and occasionally muscle. The anconeus epitrochlear or triceps muscle can put pressure on the ulnar nerve.  Repetitive elbow flexion activities can contribute to symptoms. Some patients develop cubital tunnel because of arthritis or previous fracture to the elbow.

What are the symptoms of cubital tunnel syndrome?

Patients typically notice numbness in the ring and small finger and weakness in the hand. Patients may drop objects or lack fine muscle coordination. The numbness can be intermittent or constant. Constant numbness and loss of muscle bulk in the had is a sign of severe cubital tunnel syndrome.

Diagnosing cubital tunnel syndrome

Diagnosis is made on clinical exam with tenderness along the ulnar nerve in the cubital tunnel and numbness with compression of the nerve. There is numbness in the small and ring finger and possible weakness of the muscles of the hand.

An electromyography and nerve conduction velocity may be performed to access severity and make sure the compression of the nerve is not coming from a different location. X-rays may be necessary to look for signs of arthritis. Numbness in the fingers may arise from a pinched nerve in the neck. Cervical spine X-rays or MRI may be needed to rule out neck compression. It is important that Dr. Kavi Sachar examine you to help make an accurate diagnosis.

Nonsurgical treatment of cubital tunnel syndrome

Treatment may begin with therapy and splinting. Patients will often wear a splint at night to keep the elbow straight and learn nerve glide exercises to mobilize the nerve. A certified hand therapist may be recommended to perform an assessment and help guide conservative treatment. If found early, nonsurgical treatment is often successful.

Surgically treating cubital tunnel syndrome

In severe cases or those that do not respond to therapy, surgery may be indicated. Surgery involves decompression of the nerve by releasing Osborne’s ligament and other structures. The incision can be as short as 2 inches if a simple in situ decompression is performed. On some occasions, the ulnar nerve is transposed which involves moving the nerve 2 inches from its normal location to prevent the nerve kinking at the medial epicondyle. The incision is slightly longer if an ulnar nerve transposition is needed.   The decision to transpose the nerve is based on many factors and does not affect outcome.

Recovering from cubital tunnel syndrome

Patients are sometimes immobilized in a splint after surgery followed by therapy. Patients are typically able to resume normal activities within 3 weeks.

Results depend on how severe the nerve damage is before surgery. For This reason, Dr. Kavi Sachar prefers to identify and treat cubital tunnel early to obtain the best possible outcome.

Schedule a consultation

Board-certified and fellowship-trained hand surgeon Dr. Kavi Sachar is widely regarded as one the nations leading experts on cubital tunnel syndrome. Dr. Sachar has three office locations in Vail, Aspen, and Frisco, Colorado. If you or a family member suffer from cubital tunnel syndrome, contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.