Cubital tunnel syndrome


Cubital tunnel syndrome

Description, Causes and Risk Factors:

A group of symptoms that develop from compression of the ulnar nerve within the cubital tunnel at the elbow; can include paresthesia into the 4th and 5th digits and weakness of the intrinsic muscles of the hand.

Cubital tunnel syndrome

Cubital tunnel syndrome is a condition that affects the ulnar nerve where it crosses the inside edge of the elbow. The symptoms are very similar to the pain that comes from hitting your funny bone. When you hit your funny bone, you are actually hitting the ulnar nerve on the inside of the elbow. There, the nerve runs through a passage called the cubital tunnel. When this area becomes irritated from injury or pressure, it can lead to cubital tunnel syndrome.

Cubital tunnel syndrome has several possible causes. Part of the problem may lie in the way the elbow works. The ulnar nerve actually stretches several millimeters when the elbow is bent. Sometimes the nerve will shift or even snap over the bony medial epicondyle. Over time, this can cause irritation.

One common cause of problems is frequent bending of the elbow, such as pulling levers, reaching, or lifting. Constant direct pressure on the elbow over time may also lead to cubital tunnel syndrome. The nerve can be irritated from leaning on the elbow while you sit at a desk or from using the elbow rest during a long drive or while running machinery. The ulnar nerve can also be damaged from a blow to the cubital tunnel.

Other risk factors:

    Constricting fascial bands.

  • Subluxation of the ulnar nerve over the medial epicondyle.

  • Cubitus valgus.

  • Bony spurs.

  • Joint deformity in osteoarthritis or rheumatoid arthritis.

  • Direct compression, e.g. habitual leaning on elbows.

  • Repetitive elbow flexion and extension, heavy manual work, frequently playing guitar.

  • Golfer's elbow.

  • Tumors.

  • Ganglia.

  • Diabetes mellitus.

Symptoms:

Cubital tunnel syndrome symptoms usually include pain, numbness, and/or tingling. The numbness or tingling most often occurs in the ring and little fingers. The symptoms are usually felt when there is pressure on the nerve, such as sitting with the elbow on an arm rest, or with repetitive elbow bending and straightening. Often symptoms will be felt when the elbow is held in a bent position for a period of time, such as when holding the phone, or while sleeping. Some patients may notice weakness while pinching, occasional clumsiness, and/or a tendency to drop things. In severe cases, sensation may be lost and the muscles in the hand may lose bulk and strength.

Diagnosis:

The examining doctor may look for Froment's sign, overt clawing of the ulnar-innervated digits (usually the little and ring fingers) and abduction of the little fingers (Wartenberg's sign).Tapping over the cubital tunnel causes pain, tingling or shock-like sensation down the arm into the fingers (Tinel's sign).

Inspection of the elbow in extension may show a valgus deformity, possibly secondary to a previous fracture around the elbow. Malunion after supracondylar fracture of the humerus can result in an adult cubitus valgus deformity, which in turn predisposes to tardy ulnar nerve palsy.

Imaging:

    X-rays.

  • Magnetic resonance imaging (MRI).

  • High-resolution ultrasonography.

A test called electromyography (EMG) and/or nerve conduction study (NCS) may be done to confirm the diagnosis of cubital tunnel syndrome and stage its severity. This test also checks for other possible nerve problems, such as a pinched nerve in the neck, which may cause similar symptoms.

Treatment:

The early symptoms of cubital tunnel syndrome usually lessen if you just stop whatever is causing the symptoms. Anti-inflammatory medications may help control the symptoms.

Surgical options: The goal of surgery is to release the pressure on the ulnar nerve where it passes through the cubital tunnel. There are two different kinds of surgery for cubital tunnel syndrome.

    Ulnar Nerve Transposition: In this procedure, the surgeon forms a completely new tunnel from the flexor muscles of the forearm. The ulnar nerve is then moved (transposed) out of the cubital tunnel and placed in the new tunnel.

  • Medial Epicondylectomy: The other method simply removes the medial epicondyle on the inside edge of the elbow, a procedure called Medial epicondylectomy. By getting the medial epicondyle out of the way, the ulnar nerve can then slide through the cubital tunnel without pressure from the bony bump.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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