What is Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)?

Ulnar nerve neuropathy often leads to symptoms like tingling, numbness, and shooting pain along the inner side of the forearm, as well as the inner half of the ring finger and the little finger. This condition is typically due to the ulnar nerve, located at the elbow, being squeezed or irritated.

To understand its anatomy, think of the ulnar nerve like a branch from the C8 and T1 nerve roots that form a part of the brachial plexus, a network of nerves running from the spine, through the neck, and into the arm. The ulnar nerve then runs down the arm near the brachial artery and towards the elbow joint. Midway down the arm, it moves into the back compartment by passing through the intermuscular septum, an area known as the ‘arcade of Struthers’.

Following this, it goes along the inner side of the triceps muscle to enter the ‘cubital tunnel’, a channel at the elbow. Here, the nerve is sandwiched between the pointed tips of two bones and under the Osborne ligament. After exiting the cubital tunnel, it passes under a layer of muscle and then enters the forearm.

The ulnar nerve can be most commonly compressed, or squeezed, within the cubital tunnel due to its positioning and structure. But it can also be compressed at the arcade of Struthers or due to the layer of muscle. These can result in the symptoms of ulnar neuropathy.

The ulnar nerve has the responsibility of supplying sensations to the inner side of the forearm, the palm, the little finger, and half of the ring finger closest to the little finger. It also controls the muscle movements of various muscles in the forearm and hand. However, it’s important to note that the ulnar nerve doesn’t control any muscles or sensations above the elbow.

What Causes Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)?

There can be many causes of pressure on the ulnar nerve, which can lead to symptoms such as tingling along the inside of the forearm, the pinky finger, and the inside of the ring finger.

A common cause of these symptoms is pressure on the ulnar nerve. This nerve is located quite close to the surface at the inner part of your elbow; that’s why people might feel a sensation of shooting pain or an electric shock in the forearm if they bump their elbow on something hard.

Stretching the ulnar nerve can also lead to these symptoms. The ulnar nerve is located behind the inner part of your elbow. So, when you bend your elbow, this nerve gets stretched. Repetitive bending and straightening of the elbow can cause further damage and irritation to the ulnar nerve. Some people have a habit of sleeping with bent elbows, which can stretch the ulnar nerve for a long time during sleep, leading to nerve irritation. Injuries to the elbow (like fractures, dislocations, swelling, or fluid build-up) can cause physical damage leading to symptoms because of pressure or irritation of the ulnar nerve.

A study involving 117 patients found that direct pressure on the nerve due to certain sitting habits or job-related activities is a significant cause of nerve damage as the nerve passes behind the inner part of the elbow.

Risk Factors and Frequency for Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)

Ulnar nerve neuropathy, an issue where a nerve in the arm is compressed, is the second most common problem of this type, following carpal tunnel syndrome. A study that invoked 91 patients found that almost 60% of them had changes in a specific section of their arm, the cubital tunnel, that led to this ulnar nerve neuropathy. Of this group, around 20% had a condition called ‘subluxation’ of the ulnar nerve.

Other causes identified included ‘osteophytes’, a bony projection associated with the degeneration of cartilage at joints found in roughly 7% of patients.
‘Luxation’ of the ulnar nerve, which is a total dislocation of the nerve, was seen in nearly 10% of patients.
Post-traumatic lesions, which are abnormal tissues resulting from injury, caused symptoms in about 3.3% of patients.

Signs and Symptoms of Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)

If you’re experiencing a “pins and needles” sensation in your forearm and hand, particularly along the small finger and half of the ring finger, you might have a condition related to the ulnar nerve. This tingling feeling tends to get worse when you bend your elbow and might start off coming and going before gradually becoming more constant. When examined, you might show reduced sensitivity or even a complete loss of feeling in both the palm and back side of the little finger, and also in the inner portion of the ring finger.

The examiner might also use specific tests to evaluate your symptoms. One test is Tinel’s sign, where the doctor taps along the cubital tunnel (a small tunnel-like structure near the elbow where the ulnar nerve passes) to see if it increases the tingling sensation. Some other tests involve keeping your elbow bent for a minute or pressing on the ulnar nerve at the cubital tunnel area. These tests might lead to increased tingling in the areas served by the ulnar nerve, but it’s important to note that these tests are not always accurate in diagnosing the issue.

Rarely, some people might also show signs of motor symptoms, suggesting a severe case of this nerve condition. These symptoms include a weak handgrip, frequently dropping items, and in extreme cases, muscle wasting of the hand. One of the signs that doctors look for is called Froment’s sign, which indicates weakness of the thumb muscle that is managed by the ulnar nerve. In very critical cases, a deformity known as ‘ulnar claw hand’ can manifest. However, this is not likely to happen in a condition called cubital tunnel syndrome because the nerve controlling the ring finger and little finger is also affected.

Testing for Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)

Understanding the nerve pattern for the ulnar nerve, which affects muscle movement and senses touch, is crucial when evaluating patients with ulnar nerve issues, or ulnar neuropathy. A doctor can typically diagnose this condition by an examination, but they often also perform nerve conduction studies – tests that measure electrical energy to confirm the diagnosis. However, these tests may not show abnormal results in the early stages of symptoms, so they should always be interpreted in the context of the patient’s specific situation.

A doctor might order an X-ray of the elbow to rule out bone-related issues, like abnormal bone growths or old fractures, that could be pressing on the nerve.

Both ultrasound scans and magnetic resonance imaging (MRI), which are kinds of imaging tests, have an accuracy level over 80% in diagnosing ulnar neuropathy. These tests are also useful for spotting other causes of nerve pressure that might not be visible on standard X-ray images, such as soft tissue swelling or abnormal growths like neuromas, ganglion cysts, or aneurysms.

Treatment Options for Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)

Here’s a simpler way to understand what treatment options are available for patients with nerve problems.

First, doctors need to study the patient’s condition carefully to decide the best way to treat them. Sometimes, surgery is not necessary, so the doctor and patient should talk about what they hope to achieve with treatment and then choose the best approach.

Non-surgical Treatment

Some patients may only have symptoms because of certain habits or positions. For example, some people may lean too much on their elbows at work or sleep with their elbows bent. If this is causing nerve problems, then just correcting these postures can sometimes be enough to treat the problem. Interestingly, one study in Italy found that half of the patients who chose not to have surgery actually improved over time.

Another recommended treatment strategy is to wear a splint at night to keep the elbows straight. This could be a good initial option for patients with mild symptoms. Painkillers like NSAIDs can also help manage the pain.

Surgical Treatment

However, patients with severe symptoms such as muscle wasting or weak handgrip power might not get better with non-surgical treatments alone. If treatment without surgery hasn’t helped after 6 months, patients may need to consider surgery. One surgical procedure that doctors often use involves relieving the pressure on the nerve in the cubital tunnel, a narrow passageway on the inside of the elbow. Some surgeons may also choose to move the ulnar nerve to a different location.

There are quite a few ways to surgically treat cubital tunnel syndrome, including in-situ decompression, endoscopic decompression, decompression followed by a nerve relocation, or removing part of the bone and relieving the pressure on the nerve. But, studies have shown that there’s no real advantage to one surgical method over another when it comes to the patient’s final results.

When a doctor is diagnosing what might be causing discomfort or pain in your hand or arm, they take into consideration several potential conditions that could be the cause. These include:

Lesions in the Guyon canal, a tube in the wrist through which the ulnar nerve passes
Cervical spondylosis, a type of natural, age-related wear and tear that happens to the spinal disks in your neck
Brachial plexus injuries, injuries to the bundle of nerves that goes from your spine to your hand, arm, and shoulder
Thoracic outlet syndrome, a group of disorders that occur when certain blood vessels or nerves are compressed
Syringomyelia, a rare disorder in which a fluid-filled cyst forms within your spinal cord
Pancoast tumors, a type of lung cancer that begins in the upper part of the lung and spreads to nearby tissues
Motor neuron disease, a rare condition that progressively damages parts of the nervous system
Carpal tunnel syndrome, a common condition that causes pain, numbness, and tingling in the hand and arm
Polyneuropathy, a term for damage to multiple peripheral nerves throughout the body all at once

Recognizing the complexity of these potential issues, your doctor will perform the necessary tests to ensure an accurate diagnosis and appropriate treatment.

What to expect with Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)

About half of the patients notice their symptoms improving with routine care.

Possible Complications When Diagnosed with Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)

There is a possibility that one in eight patients may experience their symptoms returning after a surgical procedure to relieve pressure. The most common reason for needing additional surgery is that the first surgery did not sufficiently relieve the pressure.

It’s also important to note that the recovery from such a surgery might take time and might not be fully complete.

In some cases, symptoms might even get worse before they start to get better.

A common issue after a surgery to treat the “cubital tunnel syndrome” is damage to a certain nerve in the forearm, which can cause pain.

Common Issues After Surgery:

Recurrence of symptoms
Slow and incomplete recovery
Symptoms worsening before improvement
Pain due to damage to a nerve in the forearm

Recovery from Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)

After elbow surgery, patients are usually able to move their elbow as normal. They typically don’t need physical therapy after the procedure, unless they’re dealing with notable muscle weakness. It’s common for patients to be able to get back to light-duty work within three to four weeks.

Preventing Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)

It’s really important for patients to understand their condition and how it progresses, especially when it’s being treated using non-surgical methods. With this approach, symptoms often improve slowly, which can become quite discouraging. So, being informed about the health problem and its course can help them stay patient and committed to this kind of treatment.

When patients are prescribed certain types of pain-relief drugs, known as non-steroidal anti-inflammatory medications or NSAIDs, it’s vital to explain to them how to use these correctly and safely. They also need to know how to protect their stomach while on these drugs, as they can have some uncomfortable side effects. One effective way to do this is by taking a kind of medicine called proton pump inhibitors (PPIs). Plus, it’s generally a good idea to take NSAIDs with or just after food.