Ulnar Nerve Neuritis / Cubital Tunnel Syndrome


 

Cubital tunnel syndrome is due to excessive pressure on one of the major nerves to the arm and hand (the ulnar nerve), as it crosses around the back of the inside of the elbow.

 

Common Causes

Repeated activities with a flexed elbow, including driving, sleeping, keyboarding, weightlifting, etc.

 

Symptoms

Earliest symptoms are numbness, tingling, or pain in the ring and small fingers, at night or with the aggravating activity. Later on, weakness and coordination difficulties develop.

 

Physical Findings

History and physical examination, with a positive ‘Tinel’s sign’, and ‘Elbow Flexion Test’. Impaired function of the muscles innervated by the Ulnar nerve are found late.

 

Workup

Occasionally, electrodiagnostic studies (nerve conduction tests and electromyography) will be required to confirm the diagnosis, and its severity.

 

Non-operative Treatment

Splinting, including nighttime elbow splints. Avoidance of specific activities. Anti-inflammatory medication. A single trial of a corticosteroid injection in the cubital tunnel may by quite helpful.

 

Surgical Treatment

Several surgical procedures are available, depending on the anatomy of the arm, severity of the disease, specific source of nerve entrapment, and surgeon preference. All work by taking the pressure off of the ulnar nerve, and moving it to a safer, and less compressed location.

 

Injury Comment

All nerve decompression surgeries work by taking the pressure off of the nerve, and allowing it to heal on its own. This is much like taking a ‘pot-bound’ plant, and repotting it in a larger pot. The goal of surgery is to prevent progression, and allow for the nerve to recover. Prolonged compression of a nerve may cause permanent damage. Think of a garden hose after your car has parked on it for a very long time. Even after a nerve is successfully decompressed, it may not fully recover.