What is cubital tunnel syndrome?

Cubital tunnel syndrome is the compression of the ulnar nerve (the nerve in the "funny bone” that runs in the groove on the inner side of the elbow). This nerve provides sensation to the fourth and fifth fingers. The syndrome causes feelings of pain, numbness and tingling.

Symptoms

The common symptoms of cubital tunnel syndrome are:

• Pain in your hand
• A tingling sensation
• Weakness

These feelings are often exacerbated when the elbow has been bent for a considerable amount of time, such as when leaning on something, or sleeping.

As the condition deteriorates, some patients may notice that the numbness in their hand is constant, along with feeling of weakness. You may also struggle with your grip and finger coordination. In more serious cases, muscle wastage can occur in the hand.

Causes

Pre-existing conditions such as arthritis and diabetes can lead to a patient suffering with cubital tunnel syndrome, as well as any previous fractures or dislocations of the elbow. Cysts near your elbow joint can lead to increased risk of suffering with cubital tunnel syndrome.

A build-up of fluid in the elbow can be responsible for swelling, which in turn then may compress the nerve. However, unfortunately most instances of the syndrome arise without any explainable cause.

Diagnosis

When seeking professional advice for this condition, a specialist will likely tap the ulnar nerve over your “funny bone” and your fourth and fifth fingers may feel a little shock if your nerve is compressed.  Your hands will be looked at to check strength and gripping ability.

Your shoulder, neck, elbow and wrist will be moved gently to establish if and how different positions trigger your symptoms.

An imaging test such as an X-ray can provide clarity on whether certain factors such as arthritis or bone spurs (a small outgrowth of bone) may be causing your pain.

Treatment

Before surgery is considered as a way of fixing cubital tunnel syndrome, there are several things you can do in an attempt to cure the condition. Firstly, avoid movements that could trigger the pain, tingling or numbness, such as holding a phone for long periods of time or leaning on your forearm. If you use a computer often, ensure that your chair isn’t positioned too low, as this could increase your pain levels.

A physiotherapist may provide you with a splint to use so that your elbow is more straight and movements are less bended, hopefully reducing your symptoms. “Nerve gliding” exercises may be recommended to you in order to improve mobility and lessen stiffness in your arm and wrist.

In terms of medication, you may be prescribed anti-inflammatories like ibuprofen to reduce the swelling.

Surgery

In more serious cases of cubital tunnel syndrome, surgery is needed. In most cases, this improves the feeling of numbness. The operation involves the roof of the cubital tunnel being opened so that the compression is eased. Then, the nerve is moved to the front of the elbow and the tunnel is widened.

After surgery, you should find that as the size of the tunnel has increased, there is less pressure on your ulnar nerve. The ligament will begin to heal and new tissue will grow across the division. The new growth heals the ligament, and allows more space for the ulnar nerve to slide through.

Recovery

This depends on the type of treatment you’ve had, your consultant will be able to advise you.

Post operation, you may have to wear a splint for between three to six weeks; your surgeon will advise you in your case specifically.

When can I return to normal activities?

• Work - If your job is not physically demanding, it is probable that you will be able to return to work two weeks after undergoing surgery. This of course varies from person to person, and if your job involves more heavy exertion, you may not be able to return to work this soon. Your consultant will be able to advise you on these time frames.
• Driving - You should be able to drive again once you feel completely comfortable with performing an emergency stop, gripping and controlling the steering wheel and sitting comfortably in your car. If you are unsure whether it is safe for you to drive, please speak to your specialist.
• Exercise – Very gentle hand exercises are encouraged after your surgery, to help with your hand’s mobility. Everyday activities such as getting dressed and typing will help to regain strength in your hand.

In terms of returning to heavier exercise, such as weight lifting or playing a sport, please speak to your consultant regarding this.