Cubital Tunnel Syndrome

Cubital tunnel syndrome, also known as ulnar neuropathy, is a common condition caused due to the ulnar nerve becoming compressed or irritated as it passes through the cubital tunnel.

The ulnar nerve is one of the major nerves in the arm travelling from the neck, down the inner side of the arm and into the hand providing sensation to the little finger and part of the ring finger and controlling several small muscles in the hand. The cubital tunnel is a narrow passageway at the elbow, bordered by bone, muscle, and ligaments, through which the ulnar nerve passes. Although the ulnar nerve can be constricted in several places along the way, such as beneath the collarbone or at the wrist, it is mostly compressed behind the inside part of the elbow in the cubital tunnel.  This syndrome can lead to discomfort, pain, and significant impairment.

Treatment for cubital tunnel syndrome in Cuba includes activity modification, physical therapy, splinting, medications like NSAIDs, and in severe cases, surgical procedures such as cubital tunnel release, ulnar nerve transposition, or medial epicondylectomy. The goal of treatment for cubital tunnel syndrome is to alleviate nerve compression, reduce symptoms like pain and numbness, and restore normal function and strength to the affected arm and hand.

If left untreated, cubital tunnel syndrome can lead to a number of complications, including:

• Persistent pain.
• Numbness, and tingling in the affected arm and hand.
• Muscle weakness.
• Loss of coordination.
• Permanent nerve damage.
• Impair hand function.

Types of Cubital Tunnel Syndrome

Cubital tunnel syndrome is classified based on its severity:

• Mild cubital tunnel syndrome: Characterized by intermittent symptoms like tingling and numbness in the ring and little fingers.
• Moderate cubital tunnel syndrome: Symptoms are more persistent with more frequent numbness, tingling, and occasional pain. There may be some weakness in the hand and difficulty with fine motor skills.
• Severe cubital tunnel syndrome: Symptoms are constant, with significant pain, persistent numbness, and muscle weakness. There may be noticeable muscle wasting in the hand, leading to severe impairment in hand function and dexterity.

Causes of Cubital Tunnel Syndrome

The ulnar nerve is particularly susceptible to compression at the elbow because it passes through a narrow space with minimal soft tissue for protection. However, there are several factors that can contribute to the development of cubital tunnel syndrome, including:

• Prolonged Elbow Flexion: Keeping the elbow bent for long periods, such as during phone use or sleeping.
• Direct Injury: A blow to the inside of the elbow can damage the ulnar nerve.
• Repetitive Motion: Activities that involve repetitive elbow movements.
• Pressure on the Elbow: Leaning on the elbow for extended periods.
• Anatomical Variations: Some individuals may have a naturally narrow cubital tunnel.

Symptoms of Cubital Tunnel Syndrome

The following are the most common symptoms of cubital tunnel syndrome:

• Numbness and Tingling: Often felt in the ring and little fingers and can extend up the arm.
• Pain: Typically occurs on the inside of the elbow.
• Weakness: Difficulty in finger coordination and grip strength.
• Muscle Wasting: In advanced cases, the muscles in the hand can weaken and waste away.

Diagnosis of Cubital Tunnel Syndrome

Diagnosing cubital tunnel syndrome begins with medical history review and a physical examination of the elbow, the neck and hand.  Other tests include:

• X-rays: These images are carried out to check for bone spurs, arthritis and places where bone might compress the ulnar nerve. 
• Nerve Conduction Studies: These tests measure how fast electrical signals move through the ulnar nerve.
• Electromyography (EMG): This test evaluates the electrical activity of muscles to detect nerve damage.

Treatment for Cubital Tunnel Syndrome

Treatment for cubital tunnel syndrome typically begins with non-surgical methods including medication to reduce pain, splinting and physical therapy.

Should conservative methods not produce results, surgical treatment may be an option.

Non-Surgical Options

• Splinting: Splinting is an important part of the treatment of cubital tunnel syndrome, especially beneficial in the early stages of the condition. It reduces nerve compression by keeping the elbow in a slightly extended position, preventing the exacerbation of symptoms caused by elbow flexion. It minimizes irritation and inflammation of the ulnar nerve, particularly effective during sleep when unconscious bending of the elbow can occur.
• Physical therapy: Physical therapy for cubital tunnel syndrome involves various techniques and exercises aimed at reducing symptoms, improving function, and preventing further nerve compression. Included are:
  • Range of motion exercises: To maintain and improve the flexibility of the elbow, wrist, and hand.
  • Nerve gliding exercises: To help the ulnar nerve move smoothly through the cubital tunnel and reduce adhesions.
• Elbow flexion and extension: To maintain joint flexibility and reduce ulnar nerve compression.
• Strengthening exercises: To improve the strength and stability of the muscles around the elbow and hand.
• Manual therapy: To reduce muscle tension, improve joint mobility, and decrease nerve compression.

• Ergonomic training: To educate patients on how to modify their activities and environment to reduce strain on the elbow.

• Activity modification: To identify and alter activities that exacerbate symptoms.

Surgical Options 

Surgery for cubital tunnel syndrome is indicated when:

• Conservative treatments such as physical therapy, splinting, and medications fail to alleviate symptoms.
• Severe symptoms are severe and include persistent pain, significant numbness, and tingling in the hand and finger
• Muscle weakness or wasting
• Loss of function in the hand
• Substantial nerve compression or nerve damage.

Types of surgical procedures include:

• Cubital tunnel release: During this surgical procedure an incision is made along the inside of the elbow and to cut the ligament that forms the roof of the cubital tunnel, thereby enlarging the tunnel and reducing nerve compression. This procedure helps relieve symptoms such as pain, numbness, and tingling in the hand and fingers, and can prevent further nerve damage.
• Ulnar Nerve Transposition: During this procedure, an incision is made along the inside of the elbow to relocate the ulnar nerve from its original position behind the medial epicondyle to a new location in front of it and to secure it with surrounding tissues to keep it in place. This relocation helps to avoid nerve entrapment and irritation, particularly during elbow movements.
• Medial Epicondylectomy: This surgical procedure is performed for patients with severe cubital tunnel syndrome. During the procedure, a portion of the medial epicondyle, the bony prominence on the inside of the elbow, is removed to increase space for the ulnar nerve, thereby reducing the pressure and irritation that occurs as the nerve passes through the cubital tunnel.