Ulnar neuritis (cubital tunnel syndrome)
What is cubital tunnel syndrome?
Cubital tunnel syndrome is a condition in which the ulnar nerve, under the medial (inside) aspect of the elbow (the “funny bone”) becomes irritable, causing symptoms of pain, numbness tingling and, sometimes, weakness into the ulnar (little finger aspect) side of the hand.
It is known as cubital tunnel syndrome because it occurs due to compression or entrapment or irritation of the nerve within the confines of a space called the cubital tunnel, just behind the bony prominence on the inside (medial aspect) of the elbow. It is also known as ulnar neuritis, derived from neur-, meaning nerve, and –itis, reflecting inflammation. Ulnar nerve dysfunction or inflammation may greatly decrease athletic performance in sports that require strong hand or wrist actions.
How does cubital tunnel syndrome occur?
Most commonly, neuritis is due to some irritation, compression or stretching of the ulnar nerve within the relatively restricted confines of the cubital tunnel through which it travels. The nerve is vulnerable within this space for a number of reasons:
Some patients have insidious onset of symptoms without identifiable cause.
What increases the risk?
What are the symptoms of cubital tunnel syndrome?
How is cubital tunnel syndrome diagnosed?
Diagnosis is based on history and physical exam, occasionally complemented by a nerve study known as an EMG. Important components of the history are the symptoms listed above, most commonly discomfort, burning along the inside of the elbow and/or numbness and tingling in the little and ring fingers, particularly associated with provocative athletic activities (such as throwing for a baseball pitcher or serving for a tennis player)
Typical physical exam findings include:
Are there any special tests?
How is cubital tunnel syndrome treated?
Initial treatment consists of avoiding provocative activities that precipitate symptoms. Anti-inflammatory medication and ice as necessary may be of value. Leaning on the elbow should be avoided. The use of an elbow pad or elbow splinting (usually only at night) may be recommended to prevent full bending of the elbow. Stretching and strengthening exercises of the muscles of the forearm and elbow are important. Referral to a physical therapist or an athletic trainer may be recommended for treatment.
Failure of non-operative treatment may justify surgical intervention. Surgery involves decompression of the nerve by incising over the nerve’s sheath and releasing any adhesions or compression along the course of the nerve. If the nerve is “unstable”, it is usually transferred anteriorly (in front of) the medial epicondyle (inside elbow bone) and positioned either subcutaneously (under the skin) or sub-muscular (under the muscle).
What are the complications of treatment?
Possible complications of non-operative treatment include:
Possible complications of operative treatment include:
When can you return to your sport/activity?
Return to activity is permitted as soon as symptoms have resolved. Activity modification may be necessary if the symptoms do not resolve with standard non-operative treatment. Return after surgical intervention may require three to four months depending upon whether the nerve required transposition (moving it anteriorly in front of the elbow) and the nature of the sport.
How can cubital tunnel syndrome be prevented?