In this hand surgery video, hand specialist Dr. Helgemo describes cubital tunnel syndrome

Hand specialist Dr. Stephen Helgemo of the Florida Hand Center has produced more than one hand surgery video, but this one is different because it outlines the causes and treatments of cubital tunnel syndrome.

Cubital tunnel syndrome refers to compression of the ulnar nerve in the elbow region, which in some cases can be treated by a hand specialistwith ulnar nerve transposition or cubital tunnel release. 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.

Pressure or decreased flexibility of the tissues surrounding the ulnar nerve at the elbow leads to cubital tunnel syndrome. When the nerve is damaged by injury or chronic pressure, patients may develop numbness or tingling in the little and ring fingers. Th pressure prevents the nerve from functioning properly.  Although the nerve is vulnerable in everyone, we don’t know why some people develop cubital tunnel syndrome.

Numbness or tingling in the little 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 hand specialist perform an examination in the office, including specific tests to provoke the symptoms of cubital tunnel syndrome.

Activity modification or avoiding putting pressure on the ulnar nerve is the first step in treatment, which is intended to help patients avoid the need for elbow or hand surgery. The hand surgery videoabove talks about some of the exercises. If symptoms continue, surgery may be suggested. Elbow or hand surgery, the videosays, is also recommended when severe nerve damage is identified during the evaluation.

Ulnar nerve transposition is the recommended surgery for cubital tunnel syndrome. In this surgery, the ulnar nerve is identified and freed from adhesions and then moved to the front of the elbow. It is often placed under the muscle where it is protected from further damage. Ulnar nerve transposition is an outpatient procedure, and is usually done under “twilight”, not general anesthesia.

Cubital tunnel release is another type of surgery used to rectify the situation, but cubital tunnel surgery is often not as effective as ulnar nerve transposition. Although many patients will see rapid improvement in their symptoms, it is not uncommon for the recovery to be slow and even incomplete. The evaluation by a hand specialistlike those at Florida Hand Center, along with the nerve testing, can often help in predicting this.