Mr Prash Jesudason MB, ChB, MSc., FRCSEd (Trauma & Orth), Dip. Hand Surg (Br)
Cubital Tunnel Syndrome - Ulnar Nerve Compression at the Elbow
The ulnar nerve is a major upper limb nerve that supplies sensation to the inner part of the hand and forearm, and movement to most of the small muscles of the hand. In a syndrome similar to carpal tunnel syndrome, this nerve can also be compressed. The two sites of compression are at the elbow and at the wrist, were the nerve passes through tight canals. When the elbow is the site of compression, it is often referred to as “Cubital tunnel syndrome” and when compression as at the wrist “ Guyon’s canal compression.”
What are the symptoms?
Pain and paraesthesia (pins and needles) experienced over the inner aspect of the elbow, forearm and hand. In severe cases this can be associated with weakness and even wasting of the muscles of the hand.
What are the causes?
Similar to carpal tunnel syndrome, the cause of compression is generally unknown. Activities that cause excessive elbow flexion, or prolonged “leaning” on the elbows may predispose to cubital tunnel syndrome.
How is it assessed?
The diagnosis is usually made by the history and examination, however nerve conduction tests are usually requested to substantiate the diagnosis.
What is the treatment?
In all mild cases a trial of non-operative treatment can be tried, with a functional assessment, avoidance of precipitating factors and an extension splint to the elbow, that can be used at night. Surgical decompression is often recommended, especially in the presence of severe nerve compression. Occasionally, the nerve is brought from behind the elbow to in front of it (transposition). I do this in recurrent cubital tunnel syndrome, cubitus valgus (excessive lateral [outward] alignment of the elbow] and if there is painful clicking of the nerve on elbow movement.
What is the recovery period?
Generally, absorbable sutures are used. The wound is reviewed at 7 to 10 days after surgery. Many patients can drive and return to work at this stage, but this is dependent on the individual’s response to the operation. In most cases patients regain full strength and movement between by 6 weeks
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