Cubital Tunnel Syndrome
Heard of Cubital Tunnel Syndrome? Probably not but you may have heard of Carpal Tunnel Syndrome. Well they are similar but Carpal Tunnel Syndrome is in the wrist and hand whereas Cubital Tunnel Syndrome is in the Elbow.
What is Cubital Tunnel Syndrome?
Basically it is a compression
neuropathy, which means that a nerve is "trapped”. The nerve at fault in this
case is the ulna nerve and where it gets “trapped” is in the cubital tunnel of
the elbow:
See the below picture:
How common is it?
It is the second most common compression neuropathy in the
upper limb (Palmer & Hughes 2009).
What causes it?
A common cause is frequent bending of the elbow or constant
repetitive pressure on the elbow itself. This then irritates the nerve and it is
irritated too much then it becomes a “neuropathy”.
What are the symptoms?
The patient will complain of pain and numbness in the ring and
little finger and weakness is common. If left untreated then this can cause
muscle wasting in the hand.
So how do you diagnose Cubital Tunnel Syndrome?
Tinel’s sign:
Tapping over the Ulnar nerve in the cubital tunnel can cause
symptoms to the little finger.
Nerve conduction velocity test:
This is a test to measure the speed of nerve conduction. It
will be slower if the nerve is affected.
Electromyography (EMG):
This can be done alongside the Nerve conduction test and can
show lack of muscular activity in the muscles affected by Cubital tunnel
syndrome.
How do you treat it?
Conservative Treatments:
Avoid aggravating activity:
Very simply stop the aggravating activities to allow it the
time and space to settle itself down. This means anything that causes the
symptoms during the activity or after performing the activity. If it is work
related then some modified duties may need to be put into place. According to Svernlöv
et al (2009) patients with mild or moderate symptoms do well if they are
informed of the causes of the condition and how to avoid provocation.
Anti-Inflammatory medication:
Initially these may be useful to settle the inflammation in
the nerve down but shouldn’t be needed long term if you have stopped the
aggravating activities.
Splints/Supports:
If you are struggling to sleep then a splint to stop the elbow from bending can help but this would only be for the night, as movement is important
in the day. Another option is an elbow pad to stop direct pressure to the area
but this will depend on whether your work involves this issue.
Neural mobilisation:
When nerves get compressed, they inflame and they therefore
don’t like being stretched which means that they can tether or shorten. When
the nerve has settled down enough, Ulnar nerve neural mobilisations can be
performed to restore normal length and movement of the Ulnar nerve.
Muscle stretching:
The cubital tunnel is partly made up of muscles, namely the
long wrist flexors, so if these are tight then stretching can help to give
the nerve more space.
Muscle strengthening:
Obviously the muscles in the hand and forearm can waste and
weaken so it is important to strengthen these muscles to improve function.
Surgery:
If conservative treatments are unsuccessful then surgery will
be required to release the nerve.
In situ decompression:
Transposition of the Ulnar nerve into the subcutaneous, intramuscular,
or submuscular plane:
This is when the surgeon forms a new tunnel in either of
these areas and moves the nerve into this new tunnel.
Medial
epicondylectomy:
This is removal of the Medial epicondyle so that the nerve
doesn’t friction against it any longer.
Obviously for each surgery there will be a recovery process
and Physiotherapy will be needed to aid this.
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