CUBITAL TUNNEL SYNDROME
Cubital tunnel syndrome is the effect of pressure on the ulnar nerve, one of the main nerves of the hand. It can result in a variety of problems, including pain, swelling, weakness or clumsiness of the hand and tingling or numbness of the ring and small fingers. It also often results in elbow pain on the side of the arm next to the chest.
The ulnar nerve is a connection between the spinal cord and muscles of the forearm and hand as well as the skin on the pinkie side of the hand. The ulnar nerve passes across the back of the elbow, behind a bump on the inner side of the upper arm bone. This bump is called the medial epicondyle. The "funny bone" is actually the corner of the nerve as makes the bend around the elbow. Hitting the elbow at this spot tickles the nerve and gives a brief feeling of a shock or tingling.
When the elbow is bent, the nerve may be stretched and push against the bony bump.
Most people with this problem have a habit of sleeping with either their elbows bent, their arms up by their head, or both. These positions aggravate the problem. Over time, this can progressively irritate the nerve, resulting in numbness of the ring and small finger, weakness of some of the muscles of the hand and forearm, and pain. Nerve damage may occur.
What Can You Do?
"Over the counter" non-steroidal anti-inflammatory medication (NSAID), such as aspirin, ibuprofen,or naprosyn. Check with your pharmacist regarding possible side effects and drug interactions.
Take Vitamin B6 100 mg daily (not more) - controversial, but can't hurt, and might help. If you are pregnant or receiving vitamin therapy already, first check with your doctor.
A splint or brace use while sleeping to keep the elbow from bending while you sleep - there are several home remedies which may be tried at bedtime. Try at your own risk:
Wrap a towel around the elbow, like a "pig in a blanket", and hold in place with tape or safety pins.
Use a small size soft knee splint from a sports store, but wear it on the elbow.
Tie a scarf around your waist and then around your wrist.
Watch and modify your posture during the day to avoid long periods of time with your elbow bent. If you work at a desk, make more space between your work and your chest, so that your elbows are straighter more often.
Wait and watch.
What Can The Doctor Do?
Confirm that this actually is the problem. This may require special nerve tests done by a neurologist.
Prescribe stronger NSAID medication or cortisone-type medication.
Prescribe hand therapy and/or a custom prescription splint.
The most effective treatment without surgery is elbow splinting and correction of aggravating postures. Splinting while sleeping is usually not needed more than a month, because after that, your arm position during sleep changed enough to go without the splint.
Surgery for cubital tunnel syndrome is intended to provide more space for the nerve and tendons, and permanently reduce the amount of pressure on the nerve. There are several ways to do this, including the two following approaches:
One common type of surgery is to move the nerve in front of the bump so that it doesn’t catch and stretch when the elbow is bent. This is called an ulnar nerve transposition. The nerve will be moved just under the skin or beneath the muscle in the area.
Another type of operation is to remove the bump, allowing the nerve to glide forward and back as the elbow bends and straightens. This is also called medial epicondylectomy.
Other operations are also available and Dr. Kilaru can discuss your options at your office visit.
How Successful is Treatment?
Depending on several factors, conservative treatment (no surgery) may provide provide long-term relief in as many as four out of five people. Conservative treatment is usually not recommended for patients who have evidence of nerve damage.
For people who don't get better with conservative treatment, surgery helps about four out of five people. Some people will have some permanent areas of numbness around their elbow or forearm as a result of surgery.
What Happens if You Don't Have Treatments?
It depends on how much scar tissue has formed around the nerve. Some people will improve on their own, but it is impossible to predict who will. The longer the nerve is irritated, the harder it is to have a full recovery.
If the nerve has been damaged to the point that the fingers don't straighten properly, they may not recover the ability to straighten even with surgery.