Cubital Tunnel Syndrome is caused by compression of the Ulnar nerve at the elbow. The Ulnar nerve provides sensation to parts of the hand and innervates numerous muscles in the forearm and hand. The symptoms of Cubital Tunnel include numbness and tingling in the fingers (mainly the ring and small fingers), weak grip and pain in the hand and arm. Severe, long standing cases may also include muscle wasting in the hand and a claw deformity. Symptoms may become worse when the elbow is bent, for example while on the phone or when sleeping. Hitting your ‘funny bone’ is actually irritating the Ulnar nerve at the Cubital Tunnel.
Diagnosis
Cubital Tunnel Syndrome is relatively easily diagnosed by placing the elbow in a flexed posture and looking for symptoms in the forearm and hand that confirm irritation of the Ulnar nerve. The diagnosis may be confirmed by an electrical test called and EMG or nerve conduction test. It is important to rule out neck problems which can cause similar symptoms to cubital tunnel syndrome.
Treatment
Therapy
Mild cases of cubital tunnel syndrome, particularly when the symptoms occur mostly at night, may resolve with non surgical treatment including:-
- 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 when sleeping to prevent bending of the elbow
- Ergonomic education to reduce the effects of repetitive stress
- Nerve gliding exercises
- Ultrasound and icing
- Injected or oral anti-inflammatory medication
Usually patients notice a difference in symptoms within a few day but it can take up to six weeks for symptoms to fully resolve, depending on the severity and duration of the condition.
Surgery
If therapy is unsuccessful or testing demonstrates a very severe case, surgery may be an option. Surgical treatment involves ‘decompression’ of the ulnar nerve. There are several variations of how this is surgery is done. The operation is usually done under general anesthesia. It essentially involves removing the nerve from the cubital tunnel and re-routing it to remove the pressure and shorten it’s route to the hand. It is usually placed under a protective layer of fat or muscle.
Following surgery your surgeon may place you in a rigid splint or cast to prevent elbow motion. Therapy will often begin in 1 to 4 weeks depending on your surgeon’s preference and will focus on the following:-
- Regaining full motion to the arm
- Strengthening muscles that were affected by the nerve compression
- Scar management to decrease hypersensitivity and adherence of the scar
- Ergonomics education
If you have any questions about this condition or in fact anything related to Hand Therapy please do not hesitate to call or e mail us
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