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Cubital Tunnel Syndrome

Stretching from the neck to the hand, the ulnar nerve transports nerve signals to the little finger and half of the ring finger, and it also helps control movement and grip strength in the hand. The ulnar nerve passes through several choke points in the arm, one of which is the cubital tunnel, a shaft of tissue on the inside of the elbow. There, with little cushioning as it passes beneath a knob of bone called the medial epicondyle, the nerve is vulnerable to compression. That can cause pain in the elbow and numbness or tingling in the hand.

  • Symptoms

    • Difficulty performing fine tasks with the fingers (in severe cases)
    • Dull or burning pain or tenderness in the elbow
    • Loss of muscle in the hand (in severe cases)
    • Reduction of grip strength (in severe cases)
    • Sporadic numbness or tingling in the ring and little fingers, typically when the elbow is bent
  • Prevention

    • Avoid activities that require keeping the elbow bent for long periods of time. Patients who have to participate in these activities should regularly take breaks to stretch or reposition the elbow.
    • Patients who frequently have to bend their elbow should use a pad to avoid resting the joint on a hard surface.
    • Patients without diabetes should take steps to prevent developing the condition, and those who have diabetes should manage it appropriately.
    • Make healthy changes to daily habits to lose weight, which may help prevent cubital tunnel syndrome.
  • Risk factors

    • Arthritis of the elbow
    • Bone spurs in the elbow
    • Cysts around the elbow
    • Diabetes
    • Fluid accumulation that causes swelling in the elbow
    • History of elbow fracture or dislocation
    • Obesity
    • Repeatedly bending, flexing or leaning on the elbow
  • Diagnosis

    • Discussion of medical history and symptoms. Patients should tell their healthcare provider about symptoms, prior injuries or conditions, and work and hobbies that affect the elbow. Patients should also discuss medications they take or have tried in the past.
    • Physical examination. The healthcare provider will check the function and movement of the elbow and see whether certain actions cause symptoms. The healthcare provider may tap the patient’s funny bone — the spot where the ulnar nerve passes beneath the medial epicondyle — or ask him or her to bend joints from shoulder to wrist to see whether symptoms occur.
    • Imaging tests. X-rays can help rule out other potential causes or locations of nerve pain.
    • Nerve tests. An electromyogram or nerve conduction study can track signals along the ulnar nerve and help pinpoint where compression is happening.
  • Treatment

    • Change daily habits. The most important change patients can make is to avoid repetitive bending of the elbow or bending it for long stretches, if possible. Patients can wear a splint or brace, or wrap the arm in a towel to keep it straight during sleep.
    • Medication. Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs, can reduce pain and swelling.
    • Physical therapy. A physical therapist can help patients identify activities that may cause symptoms, show them how to modify daily habits to reduce discomfort and teach exercises to improve strength and range of motion.
    • Surgery. Surgery may be necessary if conservative treatments don’t provide relief, or if nerve compression or related damage is severe. A surgeon can open the top of the cubital tunnel to give the ulnar nerve more room, reposition the nerve to reduce compression or remove part of the medial epicondyle so it doesn’t irritate the nerve during bending.
  • Follow-up care

    • Patients who have surgery may need to wear a splint and perform physical therapy before resuming normal activities.