Cubital Tunnel Syndrome

Of the trillions of nerve cells in our bodies, many of us don’t realize that just a few control the motor function and sensory response of entire extremities.

The ulnar nerve runs from the neck through the full length of the arm and into the sides of each hand, down to the ring fingers and little fingers. It also grants feeling and movement in the hand and fingers, and is the largest nerve in the body that goes unprotected by soft tissue, making it highly vulnerable to injury.

The ulnar nerve controls larger forearm muscles that help with grip, as well as a majority of the small muscles in each hand that help with motor function and fine movements.

When the ulnar nerve undergoes compression following the narrowing of the cubital tunnel — due to soft tissue swelling, arthritis bone spurs, and more — the hand can lose all function. This is known as cubital tunnel syndrome.

Man wearing elbow brace to reduce pain from cubital tunnel syndrome

What is cubital tunnel syndrome?

Cubital tunnel syndrome occurs when the ulnar nerve becomes trapped in the cubital tunnel of the elbow, usually due to inflammation. It is caused by inflammatory conditions like arthritis, overuse, trauma, and more.

According to Dr. Daniel Penello, a hand & wrist surgeon at Alexander Orthopaedics, “The ulnar nerve is also known as the funny bone nerve. It’s the nerve that gets irritated when you hit your elbow. Cubital tunnel syndrome leads to numbness, tingling and eventually paralysis of the muscles [the ulnar nerve] serves.”

As soon as you begin feeling symptoms, doctors urge you to seek medical treatment, so that the cubital tunnel syndrome symptoms don’t persist.

What are the symptoms of cubital tunnel syndrome?

While cubital tunnel syndrome varies from person to person, patients often report the following symptoms:

  • Numbness and loss of feeling: Early signs of cubital tunnel syndrome include pain and numbness in the elbow. Because the ulnar nerve directly impacts the hand, as well as both ring and middle fingers, numbness and loss of feeling (like the hand being asleep) in these areas are extremely common first symptoms of cubital tunnel syndrome. These symptoms are exacerbated when the elbow is bent.
  • Loss of fine motor skills: As cubital tunnel syndrome progresses, simple tasks like turning keys or pushing to start your car become less attainable.
  • Weakness in grip strength: As cubital tunnel syndrome progresses, you may find yourself frequently dropping objects or experiencing weakness and clumsiness.
  • Claw hand: Also known as ulnar nerve palsy, this final stage of cubital tunnel syndrome causes complete paralysis of both the ring and little
    fingers, causing them to bend inward.

According to Dr. Penello, cubital tunnel syndrome is progressive, and there are multiple treatments available to slow down progression.

“If left untreated, the effects [of cubital tunnel syndrome] can be devastating. The ulnar nerve controls many of the small muscles in the hand, and will wither away if not treated by a professional.”

How is cubital tunnel syndrome diagnosed?

Doctors use multiple methods of diagnosing cubital tunnel syndrome. Starting with a fingertip test or elbow flex and shoulder internal rotation test, doctors check for pain, numbness and more.

In more advanced cases, doctors will conduct X-rays and MRIs. To assess sensitivity, overall damage and to confirm the cubital tunnel syndrome diagnosis, doctors might also recommend electromyography or nerve conduction studies.

What are the treatment options for cubital tunnel syndrome?

For symptoms that are mild or intermittent, your doctor will likely recommend conservative treatment, including:

  • Anti-inflammatory medications
  • Rest and limiting movement that aggravates or bends the elbow
  • Placing arm on an elbow pad to avoid hard surfaces and irritation
  • Wearing an elbow splint at night
  • Physical therapy
  • Corticosteroid injections to reduce swelling and pain

If debilitating symptoms persist, your doctor will likely recommend carpal tunnel surgery to relieve compression from the median nerve.

What happens in cubital tunnel surgery?

The surgical procedure to treat cubital tunnel syndrome typically begins with patients receiving local (numbing) or general (sleep-inducing) anesthesia — all to prevent pain during the procedure.

The surgeon will then make a 2-3 inch incision behind the elbow and relieve pressure on the ulnar nerve.

According to Dr. Penello, cubital tunnel surgery can be difficult to perform. While a minimally invasive approach for cubital tunnel surgery has been adopted by some orthopedic surgeons, we prefer the traditional approach at Alexander Orthopaedics.

“Cubital tunnel syndrome is a complicated condition. The [ulnar] nerve is not taking a straight course though the arm, but wraps around the back of the elbow. There are five structures that can compress the nerve, and we have to go in and release all five through surgery.”

The traditional approach allows surgeons to visualize important sensory nerves and blood vessels that cross the cubital tunnel and need to be protected. With the more minimal approach, there is a higher chance surgeons will cut one of these nerves or blood vessels.

How long does it take to recover from cubital tunnel surgery?

While patients can typically use their arm right away, they are usually more focused on their neurological issues — whether or not the nerve will recover, and just how fast.

Depending on the level of compression and damage done to the ulnar nerve, patients could take 2-3 months to heal.

What is post-operative pain like?

According to Dr. Penello, pain is rarely a major issue. While patients may experience discomfort at the surgical site — especially if they flex or lean on their elbow — they actually regain function rather quickly.

Narcotics are also typically not needed after the first few days post-operation,
and patients can return to work under certain limitations while managing pain with over-the-counter medication.

Is cubital tunnel surgery considered major surgery?

Cubital tunnel surgery may be conducted as an outpatient procedure, but that doesn’t downplay its status as a major surgery. When you discuss the surgery with your doctor, they will make you a detailed list to both help prepare and recover.

While you may feel instant relief following surgery, it is important to stick to your recovery plan and not put any undue pressure on your elbow.

Get expert treatment and personalized recovery with Alexander Orthopaedics

From diagnosis to helping manage pain and comfort — before surgery and beyond — our Alexander Orthopaedics Outpatient Advantage ensures you receive the care you deserve.

With our state-of-the-art surgical techniques, an outpatient cubital tunnel relief procedure can help you regain mobility and function in your arm, so you can get back to your everyday life sooner.

Schedule an appointment today and a member of our team will contact you within 24 hours to begin your wrist treatment.