Cubital Tunnel Syndrome
Other popular names
Ulnar Nerve Compression
Who does it affect?
It can occur in anyone.
Why does it occur?
In the majority of people, the cause is still unknown. However there are a number of conditions that that many people with cubital tunnel syndrome seem to have: pregnancy, thyroid disease, rheumatoid arthritis and wrist injuries. It is important to note that if you have one of these conditions it does not mean that you will definitely develop carpal tunnel syndrome, just you may be slightly more at risk.
Cubital tunnel syndrome occurs when the ulnar nerve is pressed at the level of the elbow on the inner side of the joint (funny bone area). The nerve passes through a narrow tunnel called the cubital tunnel. It is the area just behind the funny bone. When there is a build up of pressure in this tunnel the nerve becomes squashed and causes the symptoms of cubital tunnel syndrome.
Pins and needles in the little, and ring fingers and the inner side of the forearm. This commonly occurs at night and the patient is often awakened from sleep with the pins and needles and has to shake their hands to gain relief. Occasionally in severe cases the muscles on the front of the palm on the little finger side can become wasted causing a hollow. In such severe cases the thumb may be weak or clumsy.
Flexing the elbow for one minute may reproduce the pins and needles in the little and ring fingers.
Tapping the nerve in the cubital tunnel may cause tingling in these fingers.
Nerve conduction studies may be used to record the speed of the nerve across the elbow joint. This can be compared to the other hand, or in cases where both hands are affected, compared to the normal population. The test takes about 20 minutes and is slightly uncomfortable.
The majority of these tests are not required as I can normally tell from experience whether you have this condition or not.
Simple painkillers and resting splints can offer help. However the majority of people who have symptoms have surgery.
Most people who have cubital tunnel syndrome have surgery. The surgery is a day case procedure usually under local anaesthetic and takes about 20 minutes. A tourniquet is used; which is like a blood pressure cuff around the upper arm that prevents blood from obscuring the surgeons view. It is quite tight, but well tolerated for up to 20 minutes.
Local anaesthetic is given. Once numb the skin is cut and then the underlying fat is retracted. Care is taken not to injure sensory nerves to the tip of the elbow. At the base of the wound is a thick band of tissue called the transverse ligament (Osborne's bands).
This structure needs to be released to allow the contents of the cubital tunnel to be decompressed. Having released this ligament the elbow is bent and straightened to ensure that the nerve is stable and does not pop out from behind the funny bone. If it does the nerve needs to be brought forward in front of the funny bone permanently. The skin is sutured (stitched) and a bulky dressing is applied.
You are able to go home soon after the operation. The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers from day 1. The dressing is removed soon after your operation. The wound is cleaned and redressed with a simple dressing. Avoid forced gripping or lifting heavy objects for 2-3 weeks. The sutures are removed at about 10 days. You should notice an improvement in symptoms within a week but the final result may be realised at about 3 months.
Return to normal routine
Keep the wound dry until the stitches are out at 10 days.
Return to driving: The hand needs to have full control of the steering wheel and left hand the gear stick. You are advised to avoid driving for at least 7 days or until the stitches are removed.
Return to work: Everyone has different work environments. Returning to heavy manual labour should be prevented for approximately 4 to 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament. You will be given advice as to what you will be able to do and when.
Overall, over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any hand surgery from a minor procedure to a complex reconstruction).
- Failure to completely resolve the symptoms results in about 5% of cases. This may be due to chronic scarring of the nerve due to long duration of pre-operative pressure, symptoms suggesting this include muscle wasting and severe numbness.
- Numbness at the tip of the elbow (a nerve passes across the skin incision, care must be taken to avoid injury to this).
- Instability of the nerve (the nerve is checked to ensure it sits behind the funny bone and does not jump out during elbow movement).