Cubital Tunnel Syndrome

Nearly everyone has at least heard of carpal tunnel syndrome. A slightly less common but equally troubling condition is cubital tunnel syndrome.

Cubitus is Latin for elbow, and it is through the channel on the inside of the elbow that the ulnar nerve runs. It is much more commonly known as the "funny bone," and causes the shooting pain and strange feeling in the hand when it is accidentally hit.

Ulnar nerve compression at the elbow causes tingling and numbness in the ring and small fingers, and if left neglected, can gradually weaken many small muscles of the hand. Cubital tunnel syndrome usually develops for no explainable reason, but can also be associated with old elbow fractures or local mass or tumor compression. The symptoms can be made worse by leaving the elbow completely bent, especially if the elbow rests against a hard surface, as on a desktop while using a telephone.

It is not abnormal for a hand to occasionally "go to sleep," but if the ring and small fingers tingle every day, then treatment is in order. The goal of treatment is to reduce pressure on the nerve, initially by non-operative means, relying on surgery only in situations that do not improve. The first line of treatment is to avoid offending activities or behaviors. For instance, those individuals who "live on the phone" should add a shoulder cradle to the handset or replace it with a headset. Prolonged pressure on the elbow, such as on an armrest while at one's desk, or in a car or airplane, should be avoided. Particularly at night, extension splinting (sleeping with the elbow straight) will help to minimize pressure on the nerve, and help it recover from the day's insults. A rolled-up and safety-pinned bath towel or a velcro elbow splint can be used at night, and if necessary, during the day also.

Should symptoms persist despite conservative treatment, early surgery generally yields complete relief. Effective surgery either removes the roof or wall of the cubital tunnel to give the nerve more room or moves the nerve completely out of the tunnel. The latter procedure is probably the most commonly performed surgery to treat this condition. All surgical procedures can be performed on an outpatient basis. Patients can resume self care and desk-type activities within a few days, and return to full activities within two to three months. Delaying surgical treatment can risk permanent sensory changes in the ring and small fingers as well as muscle wasting in the hand (see photo), with associated permanent weakness and awkwardness of pinch and fine manipulation activities.