Cubital tunnel syndrome, or ulnar nerve entrapment, is one of the commonest peripheral nerve compressions,
the most common one is carpal tunnel syndrome and the second most common is compression
of the ulnar nerve which is cubital tunnel syndrome.
So as the nerve travels around the elbow along the forearm into the little and ring finger,
it also gives a small branch on the dorsal aspect of the hand, so patients with compression
of the ulnar nerve will have a little numbness on the dorsal aspect of the hand, pins and
needles and tingling sensation in a little and ring finger which is dynamic.
So, on examination if we bend the elbow and keep it bent for a while, patients start experiencing
aches pains and the tingling sensation a little and ring finger and extending elbow the symptoms
will ease off. In advanced cases, we can see muscle wasting which is the muscle wasting
in the first web space and also in the interosseous muscles, so you can see that the bones become
more prominent than they are now. There also may be muscle wasting in the hypothenar area.
In really severe cases, you may see clawing of the little and ring fingers. In early stages,
we advise patient to keep the elbow rather straight and try not to lean on the elbow.
It's quite common to have positional cubital tunnel syndrome where either long distance
drivers or patients with habits of bending the elbow and leaning on it, compress the
ulnar nerve and cause the symptoms. Once you extend the elbow, the symptoms may disappear.
So, it's usually adaptation of the daily living and really explaining what's going on so then
patient can change their habit.
Ulnar nerve compression is usually not the serious condition if recognized and treated
properly or early. Patient may end up with weakness, muscle wasting and a permanent numbness
in the little and ring finger. Once the muscle wasting happens, it's unfortunately irreversible
and means that even after successful decompression and release of the ulnar nerve the muscle
wasting still stays there. The strength of the hand may improve for over two years or
so but it's never the same as it was before.
Conservative treatment with changing activities of the daily living or perhaps even wearing
some kind of splint or brace to keep the elbow extended during the night may take a few months
for the symptoms to settle. If the symptoms don't settle or they're severe, we will perform
surgery. Surgery ‘cubital tunnel release’ is done usually either peripheral nerve block
could be a general anaesthetic, there is a small cut on the median aspect of the elbow
about 10-12 centimeters there and through the small incision, I would release the ulnar
nerve from the more proximal to the distal part. There are a few places where the nerve
could be potentially trapped, so I would release all the potential compression sites. After
surgery, patient has a bulky dressing and start gently mobilizing elbow within the bandage
and then once we take the stitches out patient is able to fully mobilize.