Orthopedics

OSPI offers the top orthopedic surgeons in Gilbert AZ and the East Valley. Drs. Mahoney, Macqueen, Stewart and Clouse offer minimally invasive General, Sports and Joint Replacement expertise.

Physical Therapy

Whether you are pre or post-operative, OSPI’s East Valley physical therapy team works with you on both active and passive treatments. Your will be in the best hands with our licensed physical therapists!

Chiropractic

The Gilbert chiropractors at OSPI offer a plethora of nonoperative pain relief options such as manipulations, laser therapy, physiotherapy and electrical stimulation.

Family Practice

OSPI offers comprehensive family practice services including allergy testing, BHRT, medical weight loss, aesthetics and full check ups.

Medical Weight Loss

Patients routinely experience dramatic, healthy weight loss with the customized programs at OSPI. The programs combine nutrition, exercise and prescription weight loss options.

Performance Training

OSPI’s integrated team of healthcare providers work with both amateur and professional athletes to maximize one’s performance with sport specific programs.

Pain Management

OSPI’s Board Certified, Fellowship Trained pain doctor offers both medication management and interventional procedures with exceptional outcomes!

Cubital Tunnel Syndrome

FAQs on Cubital Tunnel Syndrome

 

Cubital tunnel syndrome impacts about 25 in every 100,000 people. Second most reported entrapment involving peripheral nerves in the upper extremity, the syndrome commonly affects those with obesity, diabetes, and occupational tasks repeatedly involving the elbow. The disorder causes pain and weakness in the short term and has the potential to result in significant disability, if not identified and treated effectively.

What is cubital tunnel syndrome?

Cubital tunnel syndrome refers to the painful condition in the elbow caused by the compression and irritation of the ulnar nerve in the cubital tunnel, a narrow passageway covered by tissues on the inner edge of the elbow.

Ulnar nerve, a key nerve running along the hand, is responsible for empowering tiny hand muscles as well as providing “sensation to the little finger and part of the ring finger.” When it passes through the cubital tunnel, it runs close to a bony bump just under the skin. The space constraint makes entrapment and irritation highly likely in the event of the slightest possible irritation compression or pressure.

How does cubital tunnel syndrome occur?

The ulnar nerve originates at the medial brachial plexus and runs along the hand carrying sensation to ring and little fingers and the adjoining palm area. When it passes through the cubital tunnel, it runs the increased risk of being squeezed. It has to negotiate the medial epicondyle, a bony bump, and pass just under the skin without any padding. There also bones, ligaments, and muscles in and around the tunnel.

The structural composition of the cubital tunnel area makes ulnar nerve entrapment highly likely. It may even squeeze as you sleep on your elbow or repeatedly perform flexion and extension. Slight pressure can stress the nerve and irritate it. Keeping your elbow in a bent position for a long duration, bone spurs in the area, or even thickening of muscle structure in and around the tunnel may compress it. Bending may stretch it and push against the medial epicondyle.

What are symptoms of cubital tunnel syndrome?

  • Numbness or weakness in ring and little fingers (sporadic at initial stage, later constant)
  • Aching pain and swelling in the elbow
  • Worsening symptoms when bending the elbow or sleeping or leaning on it or holding a cell phone for longer duration
  • Feeling of clumsiness in the hand
  • May be stiffness in affected fingers, weak grip, reduced finger coordination while typing

What causes cubital tunnel syndrome?

The following reasons may contribute to cubital tunnel syndrome.

  • Direct compression of elbow due to external trauma, pressure, or blow
  • Ulnar nerve entrapment in the elbow associated with cubital valgus, formation of bone spurs
  • Mechanical compression of ulnar nerve during elbow movements, leaning on it, or sleeping on it
  • Ulnar nerve irritation linked to stretching and sliding back and forth on medial epicondyle caused by frequent bending of the elbow
  • Fluid buildup in the cubital tunnel
  • Arthritis of the elbow or prior fracture/ dislocation
  • Bone spurs or cysts in the elbow area
  • Thickening of tissues and muscles in and around the cubital tunnel
  • Structural changes in the elbow
  • Excessive pressing or vibration of elbows while working
  • Occupational tasks requiring excessive elbow flexion
  • Golfer’s elbow

Who are at the risk of cubital tunnel syndrome?

Those with diabetes or suffering from obesity face the increased risk of the disorder. Certain occupations requiring frequent elbow flexion and extension and keeping the hand on holding postures or vibrated for a long time also enhance the risk. Those with certain medical conditions, including arthritis of the elbow and cubital valgus, and past arm fractures may also be diagnosed with cubital tunnel syndrome.

How is cubital tunnel syndrome diagnosed?

To diagnose the cubital tunnel syndrome, doctors usually adopt the following measures.

  • Physical Examination: Symptoms are analyzed and the elbow is tested for a range of passive and active motions to determine if the ulnar nerve is entrapped. Tapping of the nerve at the elbow generate electric shock-like sensation in ring and little fingers while elbow bending may show if the nerve is sliding abnormally. Fingers are examined for sensation and strength.
  • Medical History: The patient is asked about his or her medical history or any adverse condition impacting the elbow area.
  • X-Ray: It helps to identify if structural abnormality is causing the ulnar nerve compression.
  • Nerve Conduction Test: The ulnar nerve is stimulated and its functionality across several areas is tested to check how well it is working. If there is any compression, the signal takes a longer than usual time to pass through it. Measuring the response the squeezed area is identified and treated.

What are treatments available for cubital tunnel syndrome?

Nonsurgical Treatment

  • Rest and Self-Care: Give your elbow rest. Shun activities requiring bending of your arm for long durations. Avoid resting the elbow on the armrest while typing. Also keep the chair at appropriate height to avoid too much bending of the elbow. Don’t lean on the elbow or put pressure on it. Wrap a towel or brace around your elbow while sleeping to prevent its bending.
  • Medications: Taking non-steroidal anti-inflammatory drugs inhibits swelling and pain in the elbow associated with cubital tunnel syndrome.
  • Steroid Injections: Cortisone and similar steroids injected around the area of compression prevents inflammation and pain on semi-permanent basis.
  • Assistive Devices: Using padded braces or splints keeps the elbow in a straight position and prevents squeezing of the nerve. This allows irritation and inflammation to subside.
  • Nerve Gliding Workouts: These exercises focus on facilitating smooth and hassle-free sliding of the ulnar nerve inside the tunnel and prevent stiffness in the arm. Gradual practice endows the elbow with enhanced flexibility.

Surgical Treatment

Surgery is an option where compression is of serious nature and there is no improvement despite nonsurgical treatment. The focus is on freeing the ulnar nerve from pressure causing the entrapment.

  • Cubital Tunnel Release: The roof of the tunnel is cut into two to relieve pressure on the nerve. This increases the space inside the passageway.
  • Ulnar Nerve Anterior Transposition: The route of the nerve is changed and it is rerouted through the front of the medial epicondyle under the muscles so that it is not squeezed by bony structures.
  • Medial Epicondylectomy: A part of the medial epicondyle surface is removed so that there is no smooth sliding of the ulnar nerve on the inner edge of the elbow.

References

Trehan SK, et al. Cubital Tunnel Syndrome: Diagnosis and Management. Rhode Island Medical Journal.Volume 95 No. 11 November 2012, 349-352

Friedrich JM, Robinson LR. Prognostic indicators from electrodiagnostic studies for ulnar neuropathy at the elbow. Muscle Nerve. Apr 2011;43(4):596–600.

Palmer BA, Hughes TB. Cubital tunnel syndrome. J Hand Surg Am. Jan 2010;35(1):153–63.

Apfelberg DB, Larson SJ. Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr Surg. Jan 1973;51(1):79–81.

Abuelem T, Ehni BL. Minimalist cubital tunnel treatment. Neurosurgery. Oct 2009;65(4 Suppl):A145–9.

Caliandro P, et al; Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2011 Feb 16;2:CD006839.

Kroonen LT. Cubital tunnel syndrome. Orthop. Clin. North Am. 2012;43 (4): 475-86.

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