Cubital tunnel syndrome
A medical condition in which the ulnar nerve is compressed or irritated.
The ulnar nerve is one of the important nerves in the forearm. It runs from the cervical spine down towards the hand and can be compressed in certain areas. The most common location of nerve compression is at the elbow and is called cubital tunnel syndrome.
Numbness and tingling in the fingers are the most common symptoms of cubital tunnel syndrome.
Normally, these symptoms can be kept under control with conservative treatment, but in situations where the numbness and tingling persist, surgery is needed.
WHAT CAUSES CUBITAL TUNNEL SYNDROME?
In many situations, the exact cause is unknown. The ulnar nerve is vulnerable to elbow impingement because it passes through a narrow space in the elbow and is protected by a thin layer of soft tissue.
WHAT ARE THE RISK FACTORS?
- Elbow fractures or dislocations;
- Osteophytes in elbow arthrosis;
- Elbow joint edema;
- Elbow synovial cyst;
- Repetitive or long-term activities with the elbow in flexion position.
WHAT ARE THE SYMPTOMS?
- Numbness and pain in the last 3 toes – these are more pronounced when the elbow is in flexion and can sometimes wake the patient from sleep;
- Decreased sensitivity in the last 3 fingers when the elbow is bent, making it difficult to move fingers or grasp objects;
- Weakness and decreased coordination in the fingers;
- If the nerve has been highly compressed for a long period of time, muscle atrophy occurs. In this case, complete muscle recovery is less possible, so it is very important, if you have severe symptoms or symptoms lasting for more than 6 weeks, to see your doctor.
WHAT CAN YOU DO AT HOME?
Avoid activities with your elbow in flexion for a long period of time, if you use a computer frequently, make sure the chair is not too low and do not lean your elbow against the armrest;
For drivers, do not sit for long periods of time with your hand resting on the armrests;
Keep your arm straight during sleep.
WHAT IMAGING METHODS DO WE USE?
Radiography- which can identify certain factors that lead to the development of cubital tunnel syndrome such as: osteophytes, arthrosis or vicious elbow fractures, with bone fragments that can compress or elongate the nerve;
EMG-electromyography- is the test in which the nerve is stimulated with a low intensity current, following its conduction along the nerve and can identify areas where the nerve is compressed and slowed down.
It can also determine muscle damage, which occurs secondary to nerve damage, with small needles inserted into the muscles.
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WHAT IS THE TREATMENT?
Conservative treatment
This is anti-inflammatory treatment, using anti-inflammatory drugs, cortisone injections (in this case, they must be done carefully so as not to further damage the nerve);
Elbow orthosis – which can be used at night to keep the elbow in extension;
Medical gymnastics – which allows the nerve in the elbow to glide more smoothly and prevents elbow gilding;
Surgical treatment
It is necessary when conservative treatment does not work, when the nerve is very compressed and when nerve compression leads to muscle damage.
There are several surgical procedures that relieve pressure on the nerve in the elbow:
– ulnar nerve release surgery – during the operation, the ligament that closes the cubital tunnel is cut, resulting in an increase in the space in the tunnel and the release of the nerve. After the procedure, the nerve has more sliding room in the elbow.
– Anterior ulnar nerve transposition – in many situations the nerve is moved from behind the medial epicondyle to in front of it. By moving the nerve in front of the medial epicondyle, compression of the medial epicondyle is prevented. When the nerve is moved immediately under the skin, its protection is not good, that’s why its transposition to the intramuscular or submuscular level is used;
– medial epicondylectomy- which consists in removing a part of the medial epicondyle.
RECOVERY AFTER SURGERY
depends on the type of surgery used.
Sometimes an orthotic is needed a few weeks after surgery.
In the case of submuscular transposition surgery the protective orthosis can be used for a period of 6 weeks.
After the immobilization period, a period of physiotherapy is necessary.
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