What is Cubital Tunnel Syndrome:
Cubital Tunnel Syndrome is a compression of the ulnar nerve at the level of the elbow. This is the most common place for ulnar nerve entrapment. The nerve gets compressed behind the inside part of the elbow, causing numbness and tingling in the little and ring fingers and hand.
The Ulnar nerve passes from the neck and runs down to the arm. At the elbow, it travels through the tunnel of tissue called “cubital tunnel”. Here, the nerve runs behind the medial epicondyle -a part of the humerus bone. The nerve is very superficial here and can get irritated just by pressing very hard at the site.
What are the Causes of Cubital Tunnel Syndrome:
At the elbow, the nerve runs under the medial epicondyle where it is very superficial to the skin. Any high or sudden force or irritation due to pressure can lead to a shock-like feeling to the person.
The most common cause of ulnar nerve entrapment at the elbow is keeping the elbow flexed or bent for a long period of time. Many times, people sleep with elbow bent and they wake up in the middle of the night with a feeling of finger asleep. This is due to the bent elbow stretches and irritates the nerve. So the fingers supplied by the nerve loses the ability to “feel” anything and goes numb.
- Pressure on the elbow for a long time can compress the nerve. Leaning on the elbow while sitting for a long period of time, can cause little and ring finger go numb.
- Any fluid development in the tunnel can compress the nerve in the tunnel.
- A direct blow to the inner side of the elbow can cause irritation or injury to the nerve.
- Sitting for a long time with your elbows bent and supported irritates the nerve. This is also referred to as” hitting your funny bone”.
Risk Factors of Cubital Tunnel Syndrome:
Swelling of the elbow
Fracture or dislocation of the elbow
Pressure on the back of the elbow for a long time
Arthritis of elbow
Cyst in the elbow.
Repeated activities that include elbow flexion for a long time.
What are the signs of Cubital Tunnel Syndrome:
- Numbness and Tingling of the little finger and half of the ring finger.
- The last two fingers (ring finger and little finger) “falling asleep”
- The finger symptoms are more pronounced with elbow bent. So performing any activities with elbow bent like carrying a glass, holding a phone, driving is more difficult.
- Weakness with fine motor activities due to the weakness of smaller muscles of the hand. This usually happens after the nerve is entrapped for a long time.
- Atrophy of hand muscles.
Medical treatment for Cubital Tunnel Syndrome
- The cubital tunnel syndrome often does not require any medical treatment. Many times, symptoms come and go, especially when a person feels that at night due to poor positioning.
- Gently rubbing the back of elbow, massaging the back of elbow or stretching the elbow in straight position can relieve the symptoms in mild cases.
- The medical team will treat the fracture and dislocation with either surgery or casting.
- If the entrapment is due to swelling, a physician will prescribe the medication to reduce the swelling.
- NSAIDS or steroids are the most common medications that are prescribed for nerve entrapment.
- Splinting or bracing can help to support the elbow, and reduce the symptoms. Braces at night can also help to avoid the positions that put the nerve at high risk for entrapment.
Surgical Interventions for Cubital Tunnel Syndrome
Surgical options need to be considered when all the conservative options fail and the patients remain symptomatic. Few of the common surgical treatment interventions are as follow.
- Ulnar nerve release
- Ulnar nerve anterior transposition
- Medial epicondylectomy
Rehabilitation of Cubital Tunnel Syndrome:
Nerve gliding exercises:
Ulnar nerve gliding exercises are one of the best ways to treat nerve entrapment. The idea is to stretch the nerve, remove the adhesions and help the nerve move freely in the tunnel. So technically, obtaining a position that stretches the nerve will work as nerve gliding exercise.
The ulnar stretches with elbow flexion (bent), wrist extension and fingers extended. This is best accompanied by shoulder raised to the side (either abducted or flexed to 90 degrees).
The other way to perform the gliding exercise is shoulder abducted to 90 degrees (raised at side), elbow straight, wrist extended (facing ceiling), and fingers straight. Here, one needs to bend the neck opposite side of the shoulder.
Ulnar Nerve Stretches:
Ulnar nerve stretch is also referred to as nerve tension test. This is done as an examination process to identify the shortening of the nerve. It is also useful to use the same stretch as a part of the exercise.
The clinician may choose to perform this exercise as an active exercise for a patient to do or a passive exercise. Below is how to perform the ulnar nerve stretch.
Splinting and bracing :
The brace can support the area and prevent the positioning that will irritate the nerve. Below are a few examples of the braces that you can use for ulnar nerve entrapment.
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Correction of Posture:
Poor position can sometimes lead to irritation of the nerve. Although this is usually short-lived and self-corrected, it can lead to the recurrence of the nerve injury. The recurrence can lead to more severe clinical symptoms. The posture that can lead to ulnar nerve irritation and inflammation is constant pressure on the elbow. Sitting with the elbow supported for a long time can put some extra pressure on the ulnar nerve at the place it is superficial to the skin (medial epicondyle). This can irritate or entrap the nerve.
So it is better to avoid this position for a longer period of time. One can invest in elbow pads if they have to maintain a position where they put a lot of pressure on the elbow. Stretching the elbow into a straight position every 10 to 15 minutes also help to reduce the episodes of irritations. Onc can choose to perform the exercises shown above every hour.
Patient Education:
Education on proper positioning, self-releasing the nerve tension as well as correction of malalignment is a necessary part of a physical therapy treatment plan. A clinician will educate a patient to avoid the positions that irritate the nerve. Also, to support the elbow will protective braces and splints. In recurrent cases, a PT may also educate how to self release the nerve as well as perform some gliding exercises for ulnar nerve to relieve the symptoms.
Home Exercise Program:
A patient can perform the above exercises to stretch the nerve. This will help to reduce pain and also prevent reoccurrence.