Cubital tunnel syndrome: Symptoms and treatment

Cubital tunnel syndrome (also known as ulnar nerve entrapment) is one of the commonest peripheral nerve compressions after carpal tunnel syndrome. The condition causes numbness or tingling in the ring and small fingers, and weakness in the hand.

We’ve asked leading consultant orthopaedic surgeon, Ms Anna Moon, to explain everything you need to know about the condition and whether surgery is necessary.

What are the symptoms of cubital tunnel syndrome?

The ulnar nerve is one of three main nerves in the arm. It starts from the neck and goes down into the hand. The nerve can be compressed in different places along the way, such as beneath the collarbone, at the wrist, and most commonly behind the inside part of the elbow.

Patients with cubital tunnel syndrome will have a little numbness on the dorsal aspect of the hand, pins and needles and a tingling sensation in the little and ring finger. During an examination, if we were to bend the elbow and keep it bent for a while, the patient would start to experience aches, pains and tingling. As we extend the elbow, the symptoms will ease off.

In the early stages, we advise the patient to keep the elbow straight and not to lean on it. 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. It usually requires the adaptation of daily living so the patient can change their habit.

In the most advanced cases, we can see the muscle wasting away. Also in the interosseous muscles, the bones become more prominent. There also may be muscle wasting in the hypothenar area.

In really severe cases, you may find that the little and ring fingers are in the position of claws.
 

Is the condition serious?

Ulnar nerve compression is not usually a serious condition if recognised and treated early. Patients may end up with weakness, muscle wasting and 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, it still stays there. The strength of the hand may improve over two years, but it's never the same as it was before.
 

How do you treat cubital tunnel syndrome?

Conservative treatment includes changing daily activities or perhaps even wearing some kind of splint or brace to keep the elbow extended during the night. It may take a few months for the symptoms to settle and if they don't improve or if they are severe, we will perform surgery.

Surgery, known as cubital tunnel release, is performed under general anaesthetic. A small cut is made on the median aspect of the elbow (10-12 cms) and through this 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. Peripheral nerve blocks are injected into the elbow to provide release from post-operative pain. The patient has a bulky dressing and will gently start mobilising the elbow within the bandage after surgery. Once we take the stitches out, the patient is able to fully move the area.

If you are living with cubital tunnel syndrome, do not hesitate to make an appointment with a specialist such as Ms Anna Moon via her Top Doctors profile today.