Cubital Tunnel Syndrome

 

Cubital Tunnel Syndrome or Ulna nerve compression at the elbow.

This guide provides an overview of cubital tunnel syndrome, its causes, symptoms, and treatment options. It also outlines what to expect if surgery is recommended.

What is Cubital Tunnel Syndrome?

Cubital tunnel syndrome occurs when the ulna nerve, one of the three main nerves that run from your spine to your hand, becomes compressed or irritated. This nerve controls sensation in the little and ring fingers, and powers the small muscles in your hand, playing a vital role in hand function.

The ulnar nerve passes through a tunnel on the inside of your elbow, commonly referred to as the "funny bone." Compression or irritation within this tunnel disrupts the nerve's function.

Symptoms

Early signs of cubital tunnel syndrome may include:

  • Pins and needles or intermittent numbness, especially in the little and ring fingers.
  • Pain on the inside of the elbow.

These symptoms often worsen at night or first thing in the morning. In more advanced cases, you may experience:

  • Muscle wasting between the fingers, noticeable on the back of the hand.
  • Reduced grip strength, making it harder to perform tasks like opening jars or using door handles.

Causes

While the exact cause is often unknown, contributing factors include:

  • Repeated bending of the elbow (e.g., due to work or hobbies).
  • Prolonged periods of resting with a bent elbow, such as during sleep.
  • Direct trauma to the elbow.
  • Previous elbow fractures.
  • Increased risk in individuals with obesity, osteoarthritis, diabetes, or hypothyroidism (an underactive thyroid).

Diagnosis

Your doctor will conduct a physical examination to reproduce and assess your symptoms. In some cases, nerve conduction studies (NCS) may be recommended to measure how well the ulnar nerve is functioning and to confirm the diagnosis. This involves placing electrodes on your skin to deliver small electrical impulses and assess nerve signal transmission.

Treatment Options

Mild to moderate cases of cubital tunnel syndrome can often be managed without surgery. Here are some strategies:

Activity Modification:

  • Avoid actions that worsen symptoms, such as resting your elbow on hard surfaces or prolonged bending.
  • Use ergonomic adjustments, like wearing a headset during phone calls or placing keyboards at the edge of desks

Nighttime Elbow Splints:

  • Wearing a splint at night can help keep your elbow in a neutral or slightly bent position, reducing pressure on the nerve.
  • Splints can be purchased online or made using a towel secured with tape.

Guidelines for Use:

  • Wear the splint every night for 6–8 weeks.
  • If symptoms improve but persist, continue wearing it for up to 12 weeks.

When is Surgery Recommended?

Surgery may be needed if symptoms are severe or do not improve with non-surgical treatments. The procedure, called decompression, relieves pressure on the ulnar nerve.

Benefits of Surgery:

  • Improvement in numbness, though recovery can be slow.
  • Prevention of further muscle weakness or nerve damage.

The Surgical Procedure

  • Incision: A 10cm incision is made on the inside of the elbow to release tight tissues that are compressing the nerve.
  • Anaesthetic Options: Surgery can be performed under general, local, or regional anaesthetic. Your consultant will discuss these options with you.

Risks of Surgery

While most patients experience a smooth recovery, potential risks include:

  • Infection: Whilst rare, it may require antibiotics or additional procedures.
  • Tender Scarring: Usually resolves with time and scar massage therapy.
  • Persistent Symptoms: Some numbness or weakness may continue in severe cases.
  • Complex Regional Pain Syndrome (CRPS): A rare condition causing severe pain and swelling.

If you have concerns about these risks, speak with your consultant or therapist.

Pre-Operative Preparation

Before your operation, you will attend a pre-assessment clinic where your health will be reviewed, and any necessary tests (e.g., blood tests) will be carried out.

Key Points:

  • Bring a list of your medications, including non-prescription remedies.
  • Stop smoking to reduce the risk of complications.
  • Please remove all rings from your fingers on the day of surgery

Post-Operative Care

  • Hospital Stay: The operation is usually a day case, so you’ll go home the same day. Arrange transport in advance as you cannot drive post-surgery.
  • Pain Management: Mild discomfort is normal and can be managed with over-the-counter painkillers like paracetamol.
  • Dressing Care: Remove the bulky dressing 48–72 hours after surgery, leaving the smaller wound dressing intact for another week.

Recovery Timeline

  • Driving: Resume driving when you can comfortably use your arm for daily tasks, this is typically 1–2 weeks after surgery.
  • Work: Return to work depends on your role. Light duties may resume after one week, while more demanding jobs may require additional time off.
  • Normal Activities: Most daily activities can be resumed within 1–2 weeks, depending on pain levels.

Follow-Up Care

  • You may receive a follow-up appointment before leaving the hospital. If not, contact your consultant if you have concerns.

Scar Care

  • Begin massaging your scar two weeks after surgery with a water-based cream to soften tissue and reduce sensitivity.

For further information, consult the British Society for Surgery of the Hand (BSSH): Cubital Tunnel Syndrome | BSSH.

Note: Please remove all rings from your fingers on the day of your surgery.

Contact Andrew SmithContact Chris James