Cubital Tunnel Syndrome
Why Does It Occur?
The ulnar nerve begins in the neck and runs down the inside/back of the arm. In the elbow area it passes underneath the bony prominence called the medial epicondyle, through a tunnel known as the cubital tunnel. The nerve is responsible for sensation to the pinky and the part of the ring finger as well as the wrist, but also controls majority of the muscles in the hand. The sensation one experiences when they hit their funny bone is actually a result of hitting their ulnar nerve. During prolonged elbow flexion or with direct pressure to the inside part of the elbow, the nerve is compressed against the bone causing pressure damage to the nerve. At times there are also genetic and other anatomic reasons why Cubital Tunnel Syndrome happens.
Symptoms and Diagnostic Testing:
The primary symptom of Cubital Tunnel Syndrome is numbness/tingling and/or pain in the pinky finger and the pinky side of the ring finger. One may also experience clumsiness, fine motor coordination issues, or outright weakness in the affected hand and pain in the forearm.
An EMG/NCV as well as an X-ray may be prescribed to help further elucidate and localize the site of the problem. An MRI is typically not needed, but may be prescribed if necessary.
In order to alleviate pressure to your ulnar nerve, some changes can be made in your day to day life. Keep the elbow straight as often as possible and avoid pressure on the inside part of the elbow. Flexion of the elbow past 60 degrees will tend to kink the nerve. Those who need to use the telephone frequently should consider using the opposite arm or getting a headset. Adjust your work ergonomics so that your elbows are not excessively bent and the edge of the desk is not resting on the inside part of the elbow. If you notice that you have numbness in the morning or waking you from sleep, some patients sleep with their arms curled up. Wearing an elbow brace or pad can help keep your elbow straight during sleep.
Surgery for Cubital Tunnel Syndrome may be indicated under two main conditions. If there is weakness identified in the hand muscles innervated by the ulnar nerve in addition to the above symptoms, the surgeon will often suggest surgery. The other indication for surgery is if the symptoms from Cubital Tunnel Syndrome was bothering the patient enough to want surgery despite non-operative treatment, the patient can opt to have it performed. There are different possible surgical procedures that one can pursue, but in general two main types of procedures are typically performed: decompression of the nerve, a nerve transposition.
During a nerve decompression, Dr. Steven Lee will make a small incision to expose the cubital tunnel. Overlying tissues covering the ulnar nerve will be incised to relieve the pressure on the ulnar nerve. Upon moving the elbow into flexion and extension, the nerve will be observed to determine if further modifications are necessary. A decompression typically takes about 15 minutes or surgical time to perform.
Ulnar Nerve Transposition
During an ulnar nerve transposition, Dr. Steven Lee will mobilize the ulnar nerve so that it is no longer positioned behind the bony medial epicondyle, thereby minimizing the effects of elbow flexion. The nerve can be place either under the skin (Subcutaneous transposition) or under the muscles (Submuscular transposition). The surgeon will typically make that decision based on a number of factors.
Surgery for Cubital Tunnel Syndrome often leads to successful results in greater than 95% of patients who have had the surgery performed in a timely manner. Like most nerve related surgeries, it is important to know that results of the surgery depend upon a number of factors. The most important factors are how long and how severely compressed the ulnar nerve is before surgery is performed. Because Cubital Tunnel Syndrome often does not produce super disabling symptoms until late in the progression of the disease, patients often put off having the surgery performed until it is too late. Like a rock that is squashing a garden hose, the longer the rock is pressing on the nerve, the more likely the hose can be permanently deformed after removing the rock. Similarly, Cubital tunnel surgery aims to merely take the pressure off of the nerve; therefore, if the nerve has been compressed too severely or too long, the nerve may be permanently deformed despite trying to take the pressure off of it through surgery. Many other factors affecting the surgery's success rates include the patients medical history such as Diabetes, smoking, other neurologic disorders, the body's inherent ability to heal and produce scar tissue, as well as adherence to postoperative protocols and avoiding trauma after surgery.
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Recovery after Cubital Tunnel Syndrome surgery depends somewhat on the procedure implemented. Often a splint will be applied after surgery, your fingers will be free to use immediately after surgery.
Sutures typically are removed 1-2 weeks after the surgery. Afterwards, a brace may be prescribed for several weeks. Physical therapy will often be prescribed thereafter, and can help modify scar tissue as well as expedite recovery.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.