Cubital Tunnel Syndrome

Cubital tunnel syndrome, like carpal tunnel syndrome, is one of the common nerve compression conditions of the hand and arm. It’s not quite as common as carpal tunnel, but still relatively frequent. The condition affects one of the three main nerves of the arm – the ulnar nerve as it crosses the elbow. The funny bone actually refers to this nerve.

Odds are that you’ve experienced a symptom of cubital tunnel syndrome at some point in your life. For example, you might have woken up in the morning with your small and ring fingers feeling a bit numb. Or you might start getting pins and needles in your small finger if you’re on the phone too long. These are common experiences that most people write off as unimportant, but can be markers for cubital tunnel syndrome. In more advanced cases, you can have elbow pain, constant hand numbness , and significant clumsiness with the hand . The treatment options include an elbow brace, or a surgery to relieve pressure on the nerve.

What is cubital tunnel syndrome?

The cubital tunnel is an area on the inside corner of the elbow where the ulnar nerve crosses from the arm into the forearm. The nerve is held in place in this area between the forearm and arm bones, by a strong ligament. If the ligament becomes tight for some reason, or the nerve is swollen, the pressure rises and the nerve is compressed. This compression is generally much worse when the elbow is bent, because the nerve gets stretched around the elbow joint. In addition, the nerve can be compressed in several other spots around the elbow – both in the upper arm and the forearm. Surgery for cubital tunnel syndrome has to make sure all of these spots are fully released, otherwise the condition will not resolve.

What are the symptoms of cubital tunnel syndrome?

Common symptoms of cubital tunnel syndrome are

  • Numbness and tingling in the hand and fingers
  • Elbow or hand pain
  • Weakness of the hand
  • Clumsiness, dropping small objects

Symptoms usually come on slowly. Occasionally patients can pinpoint the day on which their symptoms suddenly started. The symptoms are generally worse with activities where the elbow is bent, like holding a phone to your ear. Since there may not be any pain with this condition, patients sometimes ignore the symptoms at first. But waiting too long to treat cubital tunnel syndrome can lead to prolonged weakness of the hand. If you have any symptoms, you should be evaluated sooner rather than later.

What are the treatment options?

The exact causes that bring on cubital tunnel syndrome are not known. As a result, we don’t have a good idea of how to prevent it from developing. There are, however, two main treatments:

  1. Splints: A soft elbow splint worn at night keeps the elbow straight. This can relieve the symptoms of mild cubital tunnel syndrome. It rarely improves more advanced cubital tunnel syndrome though.
  2. Surgery: Cubital tunnel release surgery sounds simple, but requires good knowledge of hand surgery techniques. The ulnar nerve is very finicky, and doesn’t like being touched, so the surgery has to be performed very gently and with a light touch. There are two surgical options:
    • Endoscopic: A tiny incision at the elbow allows an instrument to be inserted and the tight ligament at the elbow is cut from the inside out. This is a relatively new technique, and has one very significant disadvantage – it cannot release the areas of compression other than ligament at the elbow.
    • Open: This technique requires a small incision on the inside of the elbow. From here, the nerve can be seen along its entire length and all areas of compression from the upper arm down into the forearm can be fully released. In addition, if necessary, this approach allows the nerve to be moved to be in front of the elbow (instead of on the inner surface). This allows it to not get stretched so much when the elbow is bent.
  3. Injections: Unlike carpal tunnel syndrome, the best evidence shows that injections of steroids do not help cubital tunnel syndrome.
Dr. Purushottam Nagarkar, University of Texas Southwestern Medical Center, Dallas, Plano and Frisco

Dr. Nagarkar on cubital tunnel syndrome:

You’ll notice that many of the symptoms of cubital tunnel syndrome described above are very similar to those of carpal tunnel syndrome. This is why I consider it so important to perform a thorough hand examination in every patient. Nerves are like electrical wires – if they’re not working well, they have to be evaluated from the spinal cord all the way to the fingertips. Nerves can often have a problem in two locations, and if this is not discovered, surgery may not solve your problem.

What to expect on the day of surgery:

Cubital tunnel surgery is an outpatient procedure that requires around 30 to 45 minutes to perform. Most cubital tunnel surgeries are performed with regional anesthesia. What this means is that your arm is numb during the surgery and you do not have any pain, but you will generally not require full general anesthesia.

What to expect after surgery:

  • Results: In most cases cubital tunnel syndrome occurs slowly over the course of months or years. As a result, the surgery cannot instantaneously resolve your symptoms. Numbness or weakness in the hand may take months to fully resolve, although there is usually an immediate partial improvement soon after surgery.
  • The first few days: After surgery your elbow will be in a soft dressing, but your fingers will be free. Your elbow and your hand will be numb for several hours after you return home because of the long-acting anesthetic that Dr. Nagarkar will use in surgery. It is critical that you start working on your fingers – closing them into a tight fist, and opening them all the way straight – immediately after surgery. Start these exercises on your way home from surgery. You should do this exercise 10 times per hour, or at every red light and during every commercial break (if you’re watching TV). Don’t squeeze a ball or do any other type of “strengthening” exercise – just close your fingers into a fist and open them up all the way. You should also straighten your elbow completely a few times per day to make sure it doesn’t get stiff.
  • Pain: Narcotic pain medications are rarely needed after cubital tunnel surgery – usually anti-inflammatory over the counter medications like Ibuprofen and Tylenol are all you need.
  • Incision care: Your incision will be closed with internal, dissolving stitches. You will have a bulky dressing on your incision after surgery, which you should keep clean and dry. When you are showering, cover your arm with a plastic bag place a couple of rubber bands around the bag to prevent water from getting onto the dressing. You can remove the dressing four days after surgery. At that point, you can start washing your arm in the shower with regular soap and water – make sure to pat the incision dry afterwards. If you like, you can cover it with an ace wrap, but this is not necessary.
  • Work: You should be able to return to desk work or light work the day after surgery. For work involving any manual labor or lifting over 10 lbs, you should plan on taking at least 2 weeks off.
  • Activities and exercise: You will be able to return to every-day activities, like typing and eating, immediately after surgery. You can drive when you are no longer using narcotic pain medications and when you are able to fully control your car. This often takes a few days to a week. Aerobic exercise can be started 2 weeks after surgery (when your dressing is removed). Exercise involving heavy lifting or any significant elbow movement (like yoga or push-ups) should be stopped for 3 weeks.
  • Hand therapy: Most patients don’t require supervised hand therapy after this surgery. However, if you need some help getting full motion back in your hand or elbow, Dr. Nagarkar will refer you to a certified hand therapist who can help you improve your function.
  • Follow-up visits: You will see Dr. Nagarkar in the office usually 7 – 10 days after surgery to examine the incisions, and ensure that you are healing appropriately. Most patients don’t require further visits. We encourage you to contact us at any time if you have any questions or concerns.

To meet Dr. Nagarkar in person, schedule your consultation or call us.