What is it?
Cubital tunnel syndrome refers to compression of the ulnar nerve in the elbow region. The ulnar nerve is vulnerable at the elbow; a blow to it can give the sensation of an electrical shock that can go into the fingers. For this reason, where the nerve passes by the inside of the elbow is often called the “crazy” or “funny” bone. When the nerve is damaged by injury or chronic pressure, you may develop numbness or tingling in the small and ring fingers.
What causes it?
Pressure or decreased flexibility of the tissues surrounding the ulnar nerve at the elbow can lead to cubital tunnel syndrome. This prevents the nerve from functioning properly. This can result from a specific injury such as a blow to the elbow. More commonly, it comes from chronic (long-term) damage to the nerve. This may be seen in someone who rests too much on his or her elbows. Although the nerve is vulnerable in everyone, we don’t know why some people develop cubital tunnel syndrome versus others.
How is it diagnosed?
Numbness or tingling in the small finger raises the suspicion of Cubital Tunnel syndrome (or ulnar nerve entrapment at the elbow). More advanced cases will present with muscle loss (atrophy), clumsiness, or clawing of the fingers. The symptoms can also be seen with nerve entrapment in the neck or wrist, and these conditions should be excluded. The doctor will perform an examination in the office, including specific tests to provoke the symptoms of cubital tunnel syndrome. The function of the nerve is often tested with an EMG or NCV. These tests look at the speed that nerve impulses travel through the nerve.
What are the treatments?
Activity modification or avoiding putting pressure on the ulnar nerve is the first step in treatment of mild or intermittent cases. Keeping the elbow out of an excessively flexed (or bent) position is also important. Many patients find their symptoms are worse at night, often a result of sleeping with their elbows in a bent position. If symptoms continue, surgery may be suggested. Surgery is also recommended when severe nerve damage is identified during your evaluation.
There are several different surgical techniques used to treat cubital tunnel syndrome. For years, the standard treatment involved an extensive and invasive technique, known as a submuscular ulnar nerve transposition. Because of advances, as well as Drs. Helgemo and Olarte’s extensive experience with minimally invasive surgery, they are now able to successfully treat this condition, in most cases, with a minimally-invasive technique known as endoscopic ulnar nerve decompression.
Endoscopic ulnar nerve decompression has now become the recommended surgery for cubital tunnel syndrome. In this surgery, the ulnar nerve is identified and freed from adhesions through a small incision using a endoscope to guide the procedure. The nerve is not moved, and no muscles or tendons are cut. It is an outpatient procedure, and is usually done under a regional anesthesia, not general anesthesia. There is a recovery period before you reach maximum return of strength and feeling; the duration depends on the severity.