Cubital tunnel syndrome

Cubital tunnel syndrome is the second most common peripheral nerve compression in the upper limb, after carpal tunnel syndrome. It occurs when the ulnar nerve, which passes through the cubital tunnel on the inner side of the elbow, becomes compressed or irritated.

Symptoms

• Numbness and tingling in the ring and little fingers, particularly when the elbow is bent
• A feeling of the arm "going to sleep"
• Weakness or clumsiness of the hand
• Pain on the inner side of the elbow
• In more severe cases, wasting of the small muscles of the hand

Diagnosis

Diagnosis is based on clinical assessment and is confirmed by nerve conduction studies (NCS) and electromyography (EMG), which measure the speed and quality of electrical signals in the ulnar nerve and identify the level of compression.

Non-surgical management

Mild to moderate cubital tunnel syndrome may respond to:

• Activity modification — avoiding prolonged elbow flexion
• Night splinting — wearing a splint to keep the elbow in slight extension during sleep
• Padded elbow protection during activities
• Physiotherapy

Surgical decompression

When conservative measures fail or nerve dysfunction is significant, surgical decompression is performed. This involves releasing the tight tissue (flexor carpi ulnaris fascia and the cubital tunnel retinaculum) that overlies the nerve, relieving the compression. In selected cases, such as where the nerve is unstable or previous decompression has failed, ulnar nerve transposition (moving the nerve to the front of the elbow) may be required.

Surgery is typically performed as a day procedure under general or regional anaesthesia.