Fields of treatment / Neurosurgery / Cubital tunnel syndrome
Cubital tunnel syndrome
Cubital tunnel syndrome is the second most common compression neuropathy after carpal tunnel syndrome. Compression neuropathy is a condition caused by compression of nerves by adjacent tissue. Specifically, cubital tunnel syndrome happens at the elbow region, where ulnar nerve is compressed. The syndrome occurs mostly in patients aged 30-40. Males are 2-3 times more often affected. Aetiology that results in ulnar nerve compression is strain injury to the hand or the person may lean on their elbow a lot, mostly on a hard surface. The symptoms are more commonly shown in the dominant hand. Other risk factors that may lead to developing cubital tunnel syndrome include injury to elbow, anatomical anomaly (hypertrophic ligaments, aberrant muscle), a lipoma or a ganglion cyst.
Symptoms of cubital tunnel syndrome
The syndrome happens to the ulnar nerve as it passes through the cubital tunnel. This is a region where the nerve is unprotected and likely to be injured. When you hit the funny bone, you hit the ulnar nerve. The nerve can also get compressed right above or under your elbow. In this region it may be a ligament which causes the nerve’s irritation.
The following are the most common symptoms of cubital tunnel syndrome:
- Tingling in the ring and little fingers and in the palm of the hand
- Worsened fine touch sensation in the regions above
- Pain that radiates up on the inside of the elbow
- Clumsiness in the affected arm and hand, difficulty doing certain actions involving the fingers (buttoning clothes, grasping knife and work)
- Muscle atrophy
- weakened grasp, weak pinch in the ring and index finger, severe cases may cause claw hand deformity
Diagnostics
To confirm the diagnosis, a nerve test called EMG known as electromyography is necessary, measuring electrical response in nerves of the upper limbs. The patient’s presentation of symptoms is also assessed.
Treatment
Cubital tunnel syndrome can be managed conservatively or surgically. Early on, conservative treatments to relieve pain may include the following options: changes to patient’s routine (avoiding activities causing pain), rehabilitation, kinesiotaping, nonsteroidal medication, steroid injections. If conservative options, fail, surgical management of the syndrome is necessary. It involves surgical decompression of the nerve. This surgery can usually be done as an outpatient procedure.
The aim of the surgery is to decrease the pressure on the nerve as it travels through the cubital tunnel. It improves blood supply and removes pain. A 6cm incision is made in the elbow. The nerve is released, and pressure is taken off the nerve. Some cases may require a more complicated procedure as releasing of the nerve may not help entirely. Then the ulnar nerve is transposed before the knuckle. The surgery can be done using a general anaesthetic or a regional anaesthetic. Care is taken that mobility is unaltered.
This procedure has 85% success rate as patients have reported significant improvement of their symptoms.
